Kock to urethra: continent functional bladder replacement

Since 1950 when Bricker first described the construction of the ileal conduit, this procedure has become a standard method of urinary diversion after pelvic exenteration. Recently, increasing interest in continent diversions has resulted in the development of several new procedures, using both small bowel and large bowel to produce and internal urinary reservoir. Such reservoirs still maintain a urinary stoma which requires periodic catheterization for emptying. With the development of the Kock low-pressure urinary reservoir, it has now become possible to re-establish the continuity of the urinary system by anastomosing this internal reservoir to the posterior urethra. This procedure utilizes the distal urethral sphincter as a continence mechanism and allows functional bladder emptying without a stoma. An antireflex valve is constructed to protect the kidneys. The authors report their experience with 20 such diversions, describing the operative technique, detailing the perioperative complications and providing urodynamic evidence of restored bladder function.