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Kock urinary reservoir maturation in children and adolescents: consequences for kidney and upper urinary tract
G Abd-el-Gawad1, K Abrahamsson, E Hanson
1Department of Paediatric Surgery, Sahlgrenska University Hospital/Ostra, Göteborg University, Göteborg, Sweden. Gamal.Abd-el-Gawad@sahlgrenska.se
Insights
Kock reservoir surgery for urinary incontinence in children shows good maturation and potential for upper urinary tract improvement. Regular reservoir emptying is crucial to prevent complications and preserve renal function.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Renal Function Assessment
Background:
- Congenital urinary incontinence poses significant challenges in pediatric patients.
- Urinary diversion techniques are essential for managing complex cases.
- The Kock reservoir has been utilized for urinary diversion in children and adolescents.
Purpose of the Study:
- To evaluate the maturation process of the Kock reservoir in pediatric patients.
- To assess the impact of Kock reservoir surgery on the kidneys and upper urinary tract.
- To identify potential complications and long-term outcomes associated with this procedure.
Main Methods:
- A longitudinal study of 20 children and adolescents (10 boys, 10 girls) aged 10.8-18 years who underwent Kock reservoir surgery.
- Follow-up for 3-10 years with periodic assessments including urography, enterocystography, and renal function tests ((51)Cr EDTA clearance).
- Correlation of radiological findings with endoscopic evaluations and patient history to assess reservoir function and complications.
Main Results:
- The Kock reservoir demonstrated good positional stability in the pelvis for most patients (75%).
- Upper urinary tract dilatation was common early post-surgery but showed significant improvement within 3-12 months in most cases.
- Long-term complications included nipple dysfunction (25%) and renal function deterioration (42%), often linked to infrequent reservoir emptying and anatomical issues.
Conclusions:
- Kock reservoir surgery is an effective urinary diversion method for pediatric congenital urinary incontinence.
- Radiological and endoscopic follow-up is vital for monitoring reservoir maturation and detecting complications.
- Strict adherence to a regular reservoir evacuation regimen is recommended to minimize risks of renal damage and ensure optimal outcomes.
Objective:
To study Kock reservoir maturation in children and adolescents and its effects on the kidneys and upper urinary tract.
Methods:
Ten boys and 10 girls, aged 10.8-18 years, had Kock reservoir surgery for congenital urinary incontinence. They were followed for 3-10 years, divided into 3 different periods, and assessed with urography and enterocystography, the findings of which were correlated to renal function as measured by (51)Cr EDTA clearance, reservoir endoscopy and patient's history.
Results:
The reservoir was located in the pelvis and remained in this position throughout the whole follow-up in 75% of patients and in the lower or midabdomen in 25%. Angled efferent nipple seen on enterocystoscopy or enterocystography coincided with nipple dysfunction, reservoir malposition or infrequent reservoir emptying. Upper urinary tract dilatation was detected in 84% of patients 3 months after surgery, 25% at 1 year and 30% at 2-10 years. The dilatation was improved in 56% of patients and unchanged in 25% after 1 year. The situation continued to improve at late follow-up. New focal renal scars were radiologically detected in 1 of 19 at early and in another 1 of 17 patients at late follow-up. Progression of old scars was detected in 1 of 19 at early and in 4 of 17 at late follow-up. Eight of 19 cases had deterioration of renal function with a change in the split renal function. Of these 8 patients, 7 reported infrequent reservoir evacuation.
Conclusions:
Kock reservoir is a useful form of urinary diversion in children and adolescents with congenital urinary incontinence. Radiological examinations are good methods of follow-up of the maturation of the pouch and its effects on the urinary tract and for detection of complications. Urinary tract dilatation is a frequent finding early after surgery but it subsides in most cases 3-12 months after surgery. Long-term efferent nipple dysfunction may be the result of angulation, reservoir stones, malposition and/or overdistension. Permanent renal damage may be due to pyelonephritis, stones, infrequent reservoir emptying or urinary obstruction. A strict regime of reservoir evacuation to avoid overdistension and nipple dysfunction and to decrease the possibility of renal function deterioration is strongly advisable in these patients. It is imperative that their own management of the reservoir is continuously supervised.