[Kock's ileal reservoir: clinical course and current experience with 73 patients]

Between October 1985 and December 1993 a total of 73 patients underwent surgery for Kock's ileal reservoir (as continent urostomy in 23 patients, orthotopic vesical substitution in 36, ileo-anal reservoir in 8, and enterocystoplasty for vesical expansion [hemiKock] in 6). Overall post-operative mortality was 5.4% (3 cases in continent urostomy and 1 in pelvic-urethral reservoir). A total of 58 patients were controlled at medium and long term. In continent urostomy early complications represented 17.3%, similar to those in pelvic-urethral (16%). Late complications of continent stoma were 35% with 25% re-operations achieving complete continence in 70% of cases. In the pelvic-urethral procedure, late complications were 22.8% with 11.4% of re-operations with complete daytime continence in 82% of patients during the day and only 54% during the night. Best results for continence were obtained with the ileo-anal reservoir (functional rectosigmoid neo-bladder): 100% during the day and 87.5% during the night. Currently, a large number of patients can preserve urinary continence after radical pelvic surgery or in severe vesical dysfunctions with urinary incontinence which can not be solved using other alternatives.