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

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Abstract
To define the nature and risk of complications associated with Kock pouch urinary diversion after high dose radiation (more than 4,500 rad), we analyzed the clinical course of 44 irradiated patients and a comparable group of 42 selected retrospectively from the nonirradiated patient cohort. Of the 42 patients in the irradiated group 18 had received 4,500 to 5,700 rad and 24 had received 6,000 to 8,700 rad. With standard statistical methods we found no difference between the irradiated and control groups when compared for age, sex ratio, followup interval, surgical procedure, operative time or estimated blood loss. There were 2 operative mortalities in the irradiated and 1 in the control groups. In the immediate postoperative period there was no difference between the irradiated and control groups when compared for hospital stay, incidence of urine leak or fascial dehiscence. The irradiated group had 8 urine leaks (20 percent) and 3 patients (7.5 percent) required surgical repair. The control group had 5 urine leaks and 1 patient (2.3 percent) required repair. Diarrhea severe enough to require further hospitalization or medication was significantly more frequent in the irradiated group (18 versus 2 percent) but the postoperative stay was not significantly different (13 versus 11 days). We conclude that Kock pouch urinary diversion may be performed safely in highly irradiated patients.