KOCK VERSUS RIGHT COLON CONTINENT URINARY-DIVERSION - COMPARISON OF OUTCOME AND REOPERATION RATE

Objectives. To compare one surgeon's sequential experience with two ty pes of continent cutaneous diversion; namely, the Kock pouch (KP) and the right colon pouch (RCP). Methods. Outcomes for the final 30 KP pat ients seen during the period 1989 to 1992 and the initial 30 RCP patie nts seen between 1992 and 1995 were analyzed retrospectively. Patients differed in median age (KP 52.5, RCP 65.5 years), in number in whom m alignancy was the reason for diversion (KP 18, RCP 25), and median fol low-up period (KP 50, RCP 16 months). Results. No intraoperative compl ications or perioperative deaths occurred. Immediate postoperative com plications were mild and self-limited in both groups, with the excepti on of 1 RCP patient who developed life-threatening hemorrhage from a r uptured splenic artery aneurysm. KP patients had a statistically highe r (P<0.05) surgical revision requirement (16 patients, 26 revisions) t han RCP patients (4 patients, 4 revisions). The majority of KP revisio ns were for efferent limb problems. Of the 14 KP patients not requirin g revision, 4 have mild incontinence not warranting surgery. Three ren al units showed new mild hydronephrosis (2 KP, RCP) and are being obse rved. Prolonged diarrhea was present in 1 patient in each group, and v itamin B-12 supplementation was required in 1 KP and 2 RCP patients. C onclusions. The markedly higher rate of surgical revision with the Koc k pouch has led to our change in practice in favor of the right colon pouch for continent cutaneous urinary diversion. Copyright 1996 by Els evier Science Inc.