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The Kock ileal neobladder: updated experience in 295 male patients
D A Elmajian1, J P Stein, D Esrig
1Department of Urology, University of Southern California School of Medicine, Los Angeles, USA.
Purpose:
Since 1986 orthotopic lower urinary tract reconstruction using the Kock ileal neobladder has been our diversion of choice in patients undergoing cystectomy. We report on the first 295 male patients undergoing this procedure from May 1986 through December 1993.
Materials And Methods:
Complications were assessed, tabulated, subdivided into early (3 months or less postoperatively) and late types, and further categorized with respect to relationship to neobladder construction. Continence was individually evaluated via a detailed patient questionnaire.
Results:
The pouch related early and late complication rates were 7.2 and 11.6%, respectively, and pouch related abdominal reoperation rates were 0.0 and 1.4%, respectively. Analysis of late pouch related complications revealed 4.1% stone formation and 2.4% afferent nipple stenosis rates, and only 1 case (0.3%) of ileal urethral anastomotic stricture. Of the patients 87 and 86% reported good or satisfactory daytime and nighttime continence, respectively. With regard to age, while overall continence was similar, a significantly greater percentage of patients younger than 70 years experience good daytime and nighttime continence relative to the older counterparts. Of the patients 5% perform regular intermittent catheterization and 2.7% required an artificial urinary sphincter due to unacceptable continence.
Conclusions:
The Kock orthotopic ileal neobladder can be constructed with minimal morbidity and extraordinary functional results. We strongly advocate its use when possible.
Insights
The Kock ileal neobladder offers effective orthotopic lower urinary tract reconstruction after cystectomy, demonstrating low complication rates and high patient continence. This procedure is recommended for suitable candidates.
Area of Science:
- Urology
- Surgical Reconstruction
- Oncology
Background:
- Cystectomy necessitates lower urinary tract reconstruction.
- The Kock ileal neobladder has been utilized since 1986 for this purpose.
- This study evaluates outcomes in male patients undergoing the procedure.
Purpose of the Study:
- To assess the complication rates and functional outcomes of the Kock orthotopic ileal neobladder.
- To report on the initial 295 male patients who underwent this procedure.
- To evaluate continence rates and factors influencing them.
Main Methods:
- Complications were categorized as early (≤3 months) and late.
- Continence was assessed using a detailed patient questionnaire.
- Data were collected from May 1986 to December 1993.
Main Results:
- Early and late pouch-related complication rates were 7.2% and 11.6%, respectively.
- Daytime and nighttime continence were reported as good or satisfactory by 87% and 86% of patients, respectively.
- Younger patients (<70 years) showed better continence rates compared to older counterparts.
Conclusions:
- The Kock orthotopic ileal neobladder is associated with minimal morbidity.
- The procedure yields excellent functional results, particularly continence.
- The study advocates for the use of the Kock neobladder when feasible.