Endoscopic management of complications of continent urinary diversion

The Kock pouch continent ileal reservoir has become a therapeutic option for those patients requiring urinary diversion. Complications of this procedure do occur but fortunately many of these may be managed endoscopically without need for open surgical exploration. This report describes experience with 55 patients treated by endoscopic surgery for complications of Kock pouch urinary diversion. This includes 45 patients with stones, 3 with stenotic afferent nipple valves, 3 with suspicion of ureteral or renal pelvic tumor, and 4 with retained upper urinary tract stents. These patients may be treated with intravenous sedation only on an outpatient basis. The procedure was successful in all but 2 patients. One complication occurred when extravasation was noted from the afferent limb. The patient was treated by internal diversion, and follow-up urogram done in forty-eight hours was normal. This experience confirms that endoscopic surgery is an attractive option for treatment of many of the complications resulting from creation of a Kock pouch ileal reservoir.