Continuing experience with the continent ileal reservoir (Kock pouch) as an alternative to cutaneous urinary diversion: an update after 250 cases.

The continent ileal reservoir as conceived by Kock produces a low pressure, high capacity reservoir with continent and nonrefluxing valves constructed from ileum. From August 1982 through August 1985, 250 patients underwent this type of surgery at our institution. Of these patients 171 underwent simultaneous radical cystectomy for cancer, 60 had had a previous urinary diversion of another type and 19 had a neurogenic bladder. Our experience represents a series of expected complications and ongoing modification to the surgical technique. A total of 42 patients (16 per cent) suffered early complication resulting in an operative mortality rate of 2 per cent (5 of 250). One or more late complications necessitating 85 revisions occurred in 77 patients (31 per cent). The end result has been an overwhelming success tempered only by the need for reoperation. It is believed that the surgical modifications described will decrease further the incidence of late complications. The basic surgical premise as conceived by Kock remains a low pressure, high capacity reservoir with continent and nonrefluxing valves that can be constructed from ileum. The concept is sound and offers a genuine alternative to the patient who requires cutaneous urinary diversion.