THE KOCK POUCH URINARY RESERVOIR

The use of detubularized ileum for the Kock pouch produced a low press ure, high capacity system superior to large bowel segments that provid ed excellent continence and protection of the upper urinary tracts. Th e early enthusiasm was tempered, however, by the technically demanding aspects of the construction of the nipple valves, the early and late complications, and occasional catheterization problems. With simple mo difications in the fixation of the intussuscepted nipples, limiting us e of staples and mesh collars, and tapering of the stoma, much of thos e problems have been resolved. The nipple valve is reliable and superi or to the tunneled implant for the dilated ureter. With more widesprea d indications for continent neobladders, the hemi-Kock reservoir remai ns one of the most dependable and stable neobladders.