Kock Urinary Reservoir Maturation in Children and Adolescents: Consequences for Kidney and Upper Urinary Tract

Abd-el-Gawad, G.; Abrahamsson, Kate; Hanson, E.; Norlén, Lars; Sillén, Ulla; Stokland, Eira; Hjälmås, K

doi:10.1159/000020028

Cited by 20 publications

(8 citation statements)

References 14 publications

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“…Firstly, because IVU studies in the early postoperative phase show dilatation of the upper urinary tract in the vast majority of cases; this is clinically irrelevant because it resolves spontaneously with further follow-up. Similar observations have been made with other forms of urinary diversions [10][11][12]. Secondly, IVUs in the early phase are not necessary to exclude upper urinary tract recurrences because these develop later (28-64 months after surgery in our series).…”

Section: Discussionsupporting

confidence: 81%

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Caveats when interpreting intravenous urograms following ileal orthotopic bladder substitution

et al. 2004

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The aim of this study was to evaluate the appearance of the upper urinary tract following cystectomy and ileal orthotopic bladder substitution. Intravenous urograms (IVUs) performed preoperatively and at regular intervals postoperatively on 87 long-term survivors (minimum survival, 5 years) following ileal orthotopic bladder substitution were reviewed. Distention of the collecting system with blunted or rounded fornices was defined as dilatation. If in addition contrast medium excretion was delayed on the 5-min film, this was defined as obstruction. Collecting system dilatation was present on all IVU films obtained from most patients (80%) within 6 months of surgery, even in the absence of urinary tract obstruction. In contrast, dilatation was commonly seen only on the 20-min postinjection films (79%) on urograms performed more than 1 year following surgery, but not encountered on the other two postinjection radiographs (at 5 and 60 min). Five years after surgery, permanent obstruction was observed in only five (3%) renoureteral units. Dilatation of the upper urinary tract after ileal orthotopic bladder substitution is a frequent finding on the 5-min, 20-min, and 60-min films during the early postoperative period but is found only on the 20-min film 1 year and later after surgery. These findings should not be overinterpreted as obstruction.

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Section: Discussionsupporting

confidence: 81%

“…The most dependent part of the constructed reservoir was then anastomosed to the membranous urethra (Fig. 1b) [6,9,10].…”

Section: Surgical Techniquementioning

confidence: 99%

Caveats when interpreting intravenous urograms following ileal orthotopic bladder substitution

et al. 2004

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“…Using the Kock pouch in 20 children and adolescents, Abd-el-Gawad et al reported, in ten of 13 children (77%) and in three of seven adolescents (43%), pouch-related complications (calculus formation in six patients, stoma prolapse in three, angulation of the efferent segment in six, reflux in two, deterioration of renal function in eight, stoma stenosis in three) after a follow-up period of 6.5 years [20,21].…”

Section: Discussionmentioning

confidence: 99%

Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience

Stein¹,

Wiesner²,

Beetz³

et al. 2005

Pediatr Nephrol

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After failure of conservative treatment of neurogenic bladders (deterioration of the upper urinary tract/incontinence) continent cutaneous diversion has to be considered in those patients with irreparable urethral sphincter defects or those who are unable to perform trans-urethral self-catheterization. In this second part of the study we investigated the long-term safety of using the Mainz pouch I with regard to protecting the upper urinary tracts and to provide urine continence. Between 1985 and 2002, operations to form an ileocaecal pouch with umbilical stoma (Mainz pouch I) were performed on 70 children and adolescents of median age 15.3 years (range 5.7-20 years). During the follow-up period five patients died 2.4-14 years postoperatively of causes not related to urinary diversion. A follow-up period of 8.7 years (0.9-18) was achieved in 65 patients with 118 renal units (RUs). As compared to preoperatively, the upper urinary tracts had remained stable or improved in 113/118 RUs (95.8%) at the latest follow-up. Complete continence was achieved in 97% of patients with a continent cutaneous diversion. Surgical revisions were required for: incontinence of the outlet mechanism in 9%, stoma prolapse in 2%, stoma stenosis in 23%, pouch calculi in 15%, symptomatic reflux in 1%, ureter stenosis in 16% of the RUs with submucosal tunnel and in 3% of the RUs with an extramural tunnel. We conclude that, in patients with irreparable sphincter defect and those who are unable to perform urethral self-catheterization, continent cutaneous urinary diversion with the Mainz pouch I provides a high continence rate with preservation of the upper urinary tracts in the long run. In patients with dilated ureters, the extramural tunnel technique results in a lower complication rate.

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“…Using the ileocaecal segment for augmentation and a cutaneous stoma for CISC (Hemi-Indiana pouch), Husmann and Cain reported a re-operation rate of 48% in 62 patients [99]. Using the Kock pouch in 20 children and adolescents, Abd-el-Gawad et al reported pouch-related complications after a follow-up of 6.5 years in 10/13 children (77%) and in 3/7 adolescents (43%) [100,101].…”

Section: Surgical Complicationsmentioning

confidence: 99%

Bladder augmentation and urinary diversion in patients with neurogenic bladder: Surgical considerations

Stein

Schröder

Thüroff

2012

Journal of Pediatric Urology

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Kock Urinary Reservoir Maturation in Children and Adolescents: Consequences for Kidney and Upper Urinary Tract

Cited by 20 publications

References 14 publications

Caveats when interpreting intravenous urograms following ileal orthotopic bladder substitution

Caveats when interpreting intravenous urograms following ileal orthotopic bladder substitution

Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience

Bladder augmentation and urinary diversion in patients with neurogenic bladder: Surgical considerations

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