Long-Term Followup of the Kock and Indiana Pouch Procedures

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Abstract
Between 1984 and 1991, 115 consecutive patients underwent cutaneous continent urinary diversion comprising 76 Kock and 39 Indiana pouch procedures. The 2 different forms of achieving continent urinary diversion were subsequently compared in a long-term followup that evaluated complications, including pouch function and the need for revisions. In the Kock pouch group there were 14 (18.4%) early postoperative complications (3 months), which required 4 subsequent reoperations (5.3%). The Indiana pouch group had a similar incidence of early complications (17.9%) but there were no reservoir related problems. The long-term study group comprised 68 Kock and 37 Indiana pouch patients who were observed for 12 months or longer (mean followup 53 and 34 months, respectively). Of 9 efferent nipple valve malfunctions observed in the Kock pouch group 5 required surgical revision. Of 16 complications related to afferent limb function 15 were caused by the use of polyester fiber fabric for the anchoring collar and 8 of these 15 complications required surgical revision. The first 2 Indiana pouch patients had pouch deformities due to incomplete detubularization of the cecum that required surgical repair. Overall, surgical revisions, including minor repairs, were performed on 15 Kock pouch patients (22.1%) and 4 Indiana pouch patients (10.8%). Both forms of the procedure preserved continence to a satisfactory degree. Urinary tract stones developed in 18 patients (26.5%) from the Kock pouch group, usually on the exposed staples or the eroded, nonabsorbable collar used to construct the nipple valves. Stone formation was rare (5.4%) in the Indiana pouch group. The incidence of ureteral implantation stricture was low in both procedures. There was no significant difference in the incidence of bacteriuria between the 2 methods of urinary diversion. These data demonstrate that the Kock pouch and Indiana pouch procedures can be accomplished with the same early postoperative complication rate. Our 8-year experience showed a high incidence of Kock afferent nipple valve malfunction. However, most of these malfunctions were due to the use of a nonabsorbable collar and can be avoided. When taking this into account, therefore, it can be concluded that the Indiana pouch functions as well as the Kock pouch with roughly the same incidence of late complications and the same reoperation rate but with a lower incidence of stone formation.