[Kock's pouch: experience and clinical course in 31 patients]

To analyse the morbidity and functional results of Kock's continent urinary diversion performed since 1992 in cystectomized patients in whom the urethra could not be used.

From March 1992 to June 1998, 31 Kock's pouches were performed by 2 surgeons on a group of patients with a mean age of 54 years. Henriet's technique was used in 23 patients until 1996, and was then modified the last 8 patients in order to create a continent valve. The diversion was performed after cystectomy for bladder or gynaecological tumour in 23 cases and 1 urinary tract reconstruction in 8 cases (neurogenic bladder, destroyed urethra, conversion of Bricker diversion).

With a mean follow-up of 42 months (12 to 84), the perioperative mortality was 3.4% and immediate complications were 26%, justifying reoperation in 6.4%. Late complications predominantly consisted of disinvagination of the valve with a reoperation rate of 13%. No surgical revision for newly modified antireflux valves has been performed since 1996. The continence rate of the system, evaluated between 3 and 6 months, was 90%.

Kock's pouch is a delicate operation, clearly associated with a high morbidity in this series, as in the literature, although the results improved with experience. Indications must be confined to patients in good general condition, motivated for self-catheterization (ATS) and in whom the urethra cannot be used for bladder replacement.