An Appliance-Free, Sphincter-Controlled Bladder Substitute: The Urethral Kock Pouch

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Abstract
A modified Koch pouch was constructed in 16 patients with cancer of the bladder in whom cystoprostatectomy was indicated. Surgery entailed creation of a Koch pouch with 1 valve for prevention of reflux. The pouch then was anastomosed to the urethral stump. There was no operative mortality. Followup ranged between 3 and 9 months. Excretory urogams revealed excellent upper tract function and good evacuation of the pouch with minimal residual urine. Urodynamic studies demonstrated a volume capacity of greater than 300 ml., with pressures of less than 40 cm. water. All patients were continent during the day. Nocturnal enuresis was observed in 4 patients, 3 of whom responded favorably to I-desamino-8-D-arginine vasopressin therapy. The procedure is suitable whenever the urethra can be preserved after cystectomy for cancer.