Rethinking the known technique of heterotopic continent uroderivation and searching for optimal ways to improve functional results

Perepechay V.A., Senin S.I., Vasilyev O.N.

1) Rostov State Medical University, Rostov-on-Don, Russia; 2) Rostov Clinical Hospital – Southern Regional Medical Centre, Rostov-on-Don, Russia

Introduction. The increasing number of performed cystectomies (CE) has significantly heightened the demand for effective urinary diversion methods. The declining use of continent cutaneous urinary diversion (CCUD) leads to an impoverishment of the modern reconstructive urology arsenal and a reduced quality of life for post-cystectomy patients when orthotopic neocystoplasty is not feasible.
Aim. To conduct a comparative analysis of the clinical and functional outcomes of the classic and modified Kock pouch continent cutaneous urinary diversion.
Materials and methods. The results of a consecutive series of 56 patients were analyzed. The patients underwent: open CE with classic Kock CCUD (13 patients, 23.2%), open CE with modified Kock CCUD (27 patients, 48.2%), and laparoscopic CE with modified Kock CCUD (16 patients, 28.6%).
Results. The incidence of resecting a prolapsed valve nipple decreased by 6.2 times with the modified technique. Valve revision was required in 30.8% of patients after the classic procedure compared to 7.0% after the modified procedure, resulting in a 4.4-fold reduction in revision frequency. Reservoir calculi formation was 1.4 times lower in the modified surgery group. Difficult catheterization decreased by 23.9% (a 4.5-fold reduction) in the modified group. Continence rates were 76.9% and 93.1% in the compared groups, respectively, showing a 16.2% improvement (a 1.2-fold increase) with the modified Kock reservoir. The advantages of surgical approaches (open vs. laparoscopic) and diversion modification (modified vs. classic Kock procedure) become apparent only when considering long-term postoperative outcomes (≥90 days).
Conclusion. Despite the waning popularity of the traditional heterotopic Kock continent urinary diversion, which undoubtedly depletes the arsenal of modern reconstructive urology, its modified version represents a promising tool in the hands of a contemporary urologist.

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About the Authors

Corresponding author: S.I. Senin – urologist at the Urology Department of the Rostov Clinical Hospital – Southern Regional Medical Centre, Rostov-on-Don, Russia; e-mail: doc.senin@gmail.com

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