Naslov
Modification of the Kocks Pouch for Bladder Replacement

Autori
Tucak, Antun ; Ruđer, Novak

Izvornik
Croatian medical journal (0353-9504) 40 (1999), 4; 543-545

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
bladder; bladder neoplasms; cystectomy; surgical anastomosis; uretherostomy; urinary diversion

Sažetak
To describe a modification of the Kocks pouch and present our clinical experience in its application. After isolating an adequate ileal segment, the bowel is split by a longitudinal incision, with both ends remaining unopened for about 3-4 cm in length. Previously anastomozed ureters are inseted into the proximal end so that a nipple valve is created. The distal unsplit end serves for a direct anastomosis with the urethra. During the past 9 years, this surgery was performed in 41 patients who underwent radical cystectomy due to invasive carcinoma. Seventeen patients died for unknown reasons or were lost to follow-up. The remaining 24 were included in the follow-up for a period of 7 months to 6 years post surgery. Half of the patients included in the follw-up urinated spontaneously, with post void residuals less than 120 mL and no need for catheterization. Four patients did not urinate spontaneously and needed continuos catheterization, whereas 8 patients had post void residuals of 150-200 mL and needed catheterization once a day or once a week. None of the patients had a stricute at the site of ureteroileal anastomosis. We believe that our modification of the Kocks pouch makes the uretero-intestinal anastomosis much easier to perform ; both ureters are inserted into the unsplit bowel end, thus preventing reflux ; anastomosis with the urethra is performed under visual control ; and direct anastomosis of widely opened distal end of the bowel reduces the possibility of scar stenosis.

Izvorni jezik
Engleski

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