Continent diversion in children: modification of Kock pouch.

Continent urinary diversion with the ileum was performed in 10 children. The techniques described by Kock and modified by Skinner were modified further to avoid use of staples and a polypropylene (Marlex) collar with their potential hazards. The afferent and efferent limbs were fixed at 2 points internally to the wall of the pouch and externally by apposed multiple incisions and sutures to prevent nipple dessusception. A continent, nonrefluxing reservoir was achieved in all children. The stoma is placed at the umbilicus, which is more pleasing aesthetically, is less compromising to the abdominal wall musculature and is easier to catheterize by chair-bound, obese girls and by children with limited fine finger movements or mild spasticity.