A Comparative Study of Perioperative Complications with Kock Pouch Urinary Diversion in Highly Irradiated Versus Nonirradiated Patients

Objective: A potential strategy to decrease the high complication rate of radical cystectomy (RC) in the elderly is to avoid the use of bowel for urinary diversion. The aim of this study was to address this issue in a multicentre study of patients aged ≥75 years. Patients and Methods: We performed a retrospective, multicentre study of a consecutive series of patients aged ≥75 years who underwent RC for muscle-invasive bladder cancer between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification. Results: A total of 256 patients (68% men, mean age 79.6 years) were analysed. 204 (80%) patients received a urinary diversion with use of bowel and 52 (20%) a ureterocutaneostomy (UC). Patients with UC were older (82.0 vs. 78.9 years, p < 0.001) and had a higher ASA score (2.6 vs. 2.3, p = 0.007), while the mean Charlson score was lower (4.2 vs. 5.6, p < 0.001). Patients with UC had a shorter operating time (279 vs. 311 min, p = 0.002) and a shorter period in the intensive care unit (0.9 vs. 2.2 days). The overall rate of severe complications graded as Clavien III-V was significantly lower in the UC group (11.5%) as compared to patients receiving bowel for urinary diversion (25.0%) (p = 0.003). Severe (Clavien grade III-V) medical (3.9 vs. 10.3%) and surgical (2.1 vs. 14.1%) complications were all less frequent in the UC group. Inpatient, 30- and 90-day mortality was 5.8, 7.7 and 17.3% in the UC group as compared to 3.9, 5.9 and 6.9% in the bowel cohort, respectively. Conclusion: UC following RC is associated with a lower complication rate in geriatric patients. The constantly increasing cohort of geriatric, multimorbid patients requiring cystectomy might justify reconsideration of this form of diversion.

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Prospective Radionuclide Renal Function Evaluation and its Correlation with Radiological Findings in Patients with Kock Pouch Urinary Diversion

The Journal of Urology ◽

10.1016/s0022-5347(17)38498-7 ◽

1991 ◽

Vol 145 (5) ◽

pp. 952-955 ◽

Cited By ~ 8

Author(s):

Kuang-Kuo Chen ◽

Luke S. Chang ◽

Ming-Tsun Chen ◽

Shin-Hwa Yeh

Keyword(s):

Renal Function ◽

Urinary Diversion ◽

Function Evaluation ◽

Radiological Findings ◽

Kock Pouch

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Re: Stenosis of the Afferent Antireflux Valve in the Kock Pouch Continent Urinary Diversion: Diagnosis and Management, by J. P. Stein, J. L. Huffman, J. A. Freeman, S. D. Boyd, G. Lieskovsky and D. G. Skinner, J. Urol., 151: 338–340, 1994

The Journal of Urology ◽

10.1016/s0022-5347(17)32628-9 ◽

1994 ◽

Vol 152 (3) ◽

pp. 968-968 ◽

Cited By ~ 1

Author(s):

W. Reid Pitts

Keyword(s):

Urinary Diversion ◽

Continent Urinary Diversion ◽

Kock Pouch ◽

Diagnosis And Management ◽

Antireflux Valve

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Single staff cystectomy in a low-volume center: Oncological outcomes and complications

Canadian Urological Association Journal ◽

10.5489/cuaj.7171 ◽

2021 ◽

Vol 15 (11) ◽

Author(s):

Philipp Baumeister ◽

Davide Galioto ◽

Marco Moschini ◽

Chiara Lonati ◽

Stefania Zamboni ◽

...

Keyword(s):

Urinary Diversion ◽

Ileal Conduit ◽

Perioperative Complications ◽

Operating Time ◽

High Volume ◽

Median Number ◽

Perioperative Outcomes ◽

Limited Data ◽

Orthotopic Neobladder ◽

Low Volume

Introduction: Radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND) is a complex surgical procedure, associated with substantial perioperative complications. Previous studies suggested reserving it to high-volume centers in order to improve oncological and perioperative outcomes. However, only limited data exist regarding low-volume centers with highly experienced surgeons. We aimed to assess oncological and perioperative outcomes after RC performed by experienced surgeons in the low-volume center of Luzerner Kantonsspital, Lucerne, CH. Methods: We retrospectively analyzed data of 158 patients who underwent RC and PLND performed between 2009 and 2019 at a single low-volume center by three experienced surgeons, each having performed at least 50 RCs. Complications were graded according to the 2004 modified Clavien-Dindo grading system. Results: A total of 110 patients (70%) received an incontinent urinary diversion (ileal conduit or ureterocutaneostomy) and 48 patients (30%) received a continent urinary diversion (ileal orthotopic neobladder, ureterosigmoidostomy, or Mitrofanoff pouch). Median operating time was 419 minutes (interquartile range [IQR] 346–461). Overall, at RC specimen, 71.5% of patients had urothelial carcinoma ,12.6% squamous, 3.1% sarcomatoid, 1.2%glandular, and 0.6% small cell carcinoma. Median number of lymph nodes removed was 23 (IQR 16–29.5). Positive margins were found in eight patients (5.1%). Overall, five-year survival rate was 52.4%. The complication rate was 56.3%: 143 complications were found in 89 patients, 36 (22.8%) with Clavien ≥3. The 30-day mortality rate was 2.5%. Conclusions: RC could be safely performed in a low-volume center by experienced surgeons with comparable outcomes to high-volume centers.

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Comparison of Three Types of Continent Urinary Diversions in a Single Center

The Scientific World JOURNAL ◽

10.1100/tsw.2004.59 ◽

2004 ◽

Vol 4 ◽

pp. 135-141 ◽

Cited By ~ 2

Author(s):

Cengiz Girgin ◽

Akif Sezer ◽

Kutan Ozer ◽

Huseyin Tarhan ◽

Ahmet Bolukbasi ◽

...

Keyword(s):

Radical Cystectomy ◽

Urinary Diversion ◽

Stone Formation ◽

Late Complication ◽

Transitional Cell ◽

Complication Rates ◽

Continent Urinary Diversion ◽

Kock Pouch ◽

Ileal Loop ◽

Mainz Pouch Ii

The results including the complication and continence rates for 3 types of continent urinary diversion were evaluated. From 1992 to 1998 we performed 58 continent urinary diversions after radical cystectomy for invasive transitional cell carcinoma (TCC) of the urinary bladder. All three types of continent diversions and ileal loop procedures were discussed and patient preferences were determined. The patient preference rate for continent urinary diversion was 96.6%, and half of these patients wanted to be completely dry. Mean age of the patients was 58.2 years. Of the 58 patients, 9 (15.5%) had a Kock pouch, 15 (25.8%) had a Kock neobladder and 34 (58.6%) had sigmoidorectal pouch (Mainz-II pouch). Early and late complication rates of the three different continent diversions were evaluated. The number of complications, such as urine leakage, pyelonephritis, hydronephrosis, reflux and stone formation, were similar in all three types of diversions. Two (5.9%) Mainz pouch II patients who had stopped oral alkalinization demonstrated severe hyperchloremic acidosis. Spontaneous pouch rupture occurred in 1 of the Kock pouches. Reoperation rates were higher with the Kock pouch and Kock neobladder cases. Daytime continence rates for the Kock pouch, Kock neobladder and Mainz II pouch were 77.7%, 86.7% and 100% respectively. Even though complete dryness may not be achieved in every patient, orthotopic bladder substitution appears to be the best choice after radical cystectomy. Although it carries the risk of life-long oral alkalinization therapy, the Mainz pouch II is associated with an excellent continence rate and may be a good alternative for patients who desire to be dry.

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