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Continent urinary diversion.

D G Skinner1, G Lieskovsky, S Boyd

  • 1Division of Urology, University of Southern California School of Medicine, Los Angeles.

The Journal of Urology
|June 1, 1989
PubMed
Summary
This summary is machine-generated.

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Continent urinary diversion using the Kock ileal reservoir offers excellent continence and quality of life. Technical modifications have reduced complications, though reoperation is needed in 10-15% of patients.

Area of Science:

  • Urology
  • Surgical Innovation
  • Patient Quality of Life

Background:

  • Continent urinary diversion is a surgical option for bladder replacement.
  • The Kock ileal reservoir technique has been utilized since 1982.
  • Lower urinary tract reconstruction after cystectomy is a complex procedure.

Purpose of the Study:

  • To evaluate the efficacy and complication rates of the Kock continent ileal reservoir.
  • To assess the long-term outcomes of Kock pouch diversion.
  • To analyze technical modifications for improving patient outcomes.

Main Methods:

  • Retrospective analysis of 531 patients undergoing Kock continent urinary diversion.
  • Evaluation of early and late complications.
  • Analysis of technical modifications implemented since July 1985.

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Main Results:

  • Early complication rate of 16.2% with a 1.9% operative mortality.
  • Late complication rate decreased to 22% after modifications.
  • The Kock nipple valve mechanism effectively prevents reflux and pyelonephritis in over 95% of patients.
  • Reoperation rates for fistula or false passage at the nipple valve base are 10-15%.

Conclusions:

  • The Kock ileal reservoir is an effective internal reservoir for bladder replacement.
  • The nipple valve mechanism provides excellent continence and protects against pyelonephritis.
  • Continent urinary diversion offers a viable alternative for improving quality of life for patients requiring urinary diversion.