Kock pouch and S bladder: 2 different ways of lower urinary tract reconstruction

Many attempts have been made to develop a continent form of urinary diversion. Encouraging results have been obtained with the Kock pouch, which offers a low pressure reservoir, safe reflux protection and a reliable continent abdominal wall stoma. If urethral function could be saved without risk, anastomosis of a bowel bladder to the urethral stump is more favorable as far as cosmetics and continence are concerned. The S bladder, developed on the basis of the S pouch, is conceptualized to be a complete replacement of the lower urinary tract that offers a low pressure reservoir, safe antireflux mechanisms, continence and voiding per urethram with abdominal straining. We treated 78 patients with continent urinary diversion (Kock pouch in 46 and S bladder in 32). Continence was achieved in 87% of the patients treated with a Kock pouch, while 93.8% were continent in the S bladder group. In an effort to achieve continence day and night 43.8% of the patients treated with an S bladder required an artificial sphincter. The over-all complication rate (12.5 compared to 41.8%) and the operative complication rate (6.3 compared to 23.9%) were significantly lower in patients treated with the S bladder. Emptying by abdominal straining was possible in all patients with an S bladder. Residuals were less than 50 cc, even in patients with an artificial sphincter.