Evaluation of Kock urinary reservoir function in children and adolescents at 3-10 years' follow-up

The aim of this study was to evaluate Kock reservoir function in children a nd adolescents operated for congenital urinary incontinence and to determin e the complication rate. Reservoir function was investigated in 13 children (age range 10.8-16 years) and 7 adolescents (age range 16-18 years) throug h enterocystometry, enterocystoscopy and patient history. Patients were fol lowed up for 3-10 years. The follow-up was reported as early (3 months-2 ye ars) and late (2-10 years) postoperative periods. At early follow-up reserv oir capacity was high in four patients and normal in the remaining patients . A low reservoir pressure was accompanied by high capacity and compliance. On enterocystometry first sensation for emptying was experienced in 82% of patients at early follow-up and 92% at late follow-up. Reservoir contracti ons were recorded in 60% of patients at early follow-up and 65% at late fol low-up. The contractions were recorded at an average reservoir capacity of 270 mi at early follow-up and 340 mi at late follow-up. The complication ra te was high in the child group compared with that in adolescents. Of 13 pat ients with at least one reservoir complication 10 were from the child group . Nipple dysfunction tangled nipple, prolapsed or stenosed stoma occurred i n 35% of patients, stones in 40% and bleeding during catheterization in 15% . Revision was performed in 38% of the child group and 15% of the adolescen ts. Reservoir perforation was observed in two patients at 6 and 9 years pos toperatively. At late follow-up continence was excellent in 17 of 19 patien ts and good in 2. We conclude that the Kock reservoir is a good modality fo r urinary diversion, but the complication incidence is high in the child gr oup (<16 years). Stability of the reservoir in terms of volume and low inte rnal pressures was achieved one year after operation, except in the patient s with infrequent reservoir emptying. A time-related increase in the reserv oir sensitivity and contractility was reported on enterocystometry. Nipple dysfunction is common during the first two years after surgery, particularl y in the child group. Stones may form 3-4 years after surgery. Satisfactory continence was achieved in all patients, although a revisional operation w as necessary in some patients in order to obtain permanent continence.