URODYNAMIC STUDY OF STORAGE AND EVACUATION OF URINE INPATIENTS WITH AURETHRAL KOCK POUCH

Purpose: The urodynamics of pouch-urethra function were investigated i n patients with a urethral Kock pouch to understand mechanisms involve d in the storage and evacuation of urine, and elucidate any problems o f long-term outcome. Materials and Methods: Urodynamic evaluation was performed in 18 male patients who underwent bladder replacement with a urethral Kock pouch following radical cystectomy. Results: Good urina ry continence was achieved with normal frequency of voiding. On urodyn amics pressure within the pouch remained low during the storage phase (mean 33.2 cm. water) but markedly increased during the evacuation of urine (mean 77.3 cm. water). In 8 patients (44%) extremely high pressu re within the pouch (80 to 150 cm. water) was noted at voiding. Clean intermittent self-catheterization was initiated in a patient with high pressure within the pouch at voiding in whom pouch-ureter reflux deve loped 7 months postoperatively. The external urethral sphincter was im paired to some extent postoperatively but it contracted in response to filling of the pouch with a marked increase in urethral pressure from a mean of 31.6 to 66.3 cm. water. Conclusions: Urodynamic and radiolo gical studies will be necessary periodically since high pressure withi n the pouch at voiding might jeopardize the antireflux mechanism, lead ing to reflux and renal impairment.