URODYNAMIC FINDINGS IN PATIENTS WITH A URETHRAL KOCK POUCH AFTER RADICAL CYSTECTOMY

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Abstract
Urodynamic evaluation was performed in 11 male patients, who underwent radical cystectomy with pelvic lymph node dissection for bladder cancer followed by bladder replacement with a urethral Kock pouch, 3 to 21 months after the operation. Frequency of micturition were 4.9±1.5 times (mean±S. D.) during the day-time and 1.5±1.2 times during the night-time. Tidal volume of micturition ranged from 300 to 550ml and residual volume from 10 to 30ml. Urinary continence was completely preserved in all patients (100%) during the day-time and 8 (72.7%) during the night-time. On pouchmetry, maximum capacity of the pouch was 429.2±82.4ml, and intra-pouch pressure was 16.2±5.4cmH2O at the capacity of 200ml and 38.7±11.5cmH2O at the maximum capacity. Maximum intra-pouch pressure on voiding was 80.0±19.4cmH2O. Uroflowmetry demonstrated intermittent voiding curves in all the patients, with maximum flow rate of 15.2±6.5ml/sec, voided volume of 405.9±80.7ml and residual rate of 4.5±2.6%. Maximum intra-urethral pressure at the external urethral sphincter was 28.0±11.3cmH2O when the pouch was empty and increased in response to pouch filling up to 64.7±27.0cmH2O. Maximum urethral closing pressure and total profile length on the urethral pressure profile were 30.2±12.4cmH2O and 20.9±9.0mm, respectively, with the pouch empty, and 23.2±14.5cmH2O and 20.0±7.6mm, respectively, with the pouch full. The bladder replacement using the urethral Kock pouch is a valuable alternative for continent urinary reconstruction provided creation of a low pressure reservoir and preservation of the urethral sphincter function are achieved. On the other hand, long term effects of the high intra-pouch pressure by abdominal strain on the reservoir have not been determined. It is conceivable that this high pressure may cause functional and/or organic changes of the pouch and jeopardize the anti-reflux mechanism at the afferent limb. In a case with high intra-pouch pressure on voiding, evacuation of urine by an intermittent catheterization instead of abdominal strain may be advocated, irrespective of the residual volume.

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