Abd-el-Gawad G, Abrahamsson K, Hanson E, Norlén L, Sillén U, Sixt R, Hjälmås K
Department of Paediatric Surgery, Sahlgrenska University Hospital/Ostra, Göteborg University, Sweden.
Scand J Urol Nephrol. 1999 Jun;33(3):149-55. doi: 10.1080/003655999750015916.
The aim of this study was to evaluate Kock reservoir function in children and adolescents operated for congenital urinary incontinence and to determine the complication rate. Reservoir function was investigated in 13 children (age range 10.8-16 years) and 7 adolescents (age range 16-18 years) through enterocystometry, enterocystoscopy and patient history. Patients were followed up for 3-10 years. The follow-up was reported as early (3 months-2 years) and late (2-10 years) postoperative periods. At early follow-up reservoir capacity was high in four patients and normal in the remaining patients. A low reservoir pressure was accompanied by high capacity and compliance. On enterocystometry first sensation for emptying was experienced in 82% of patients at early follow-up and 92% at late follow-up. Reservoir contractions were recorded in 60% of patients at early follow-up and 65% at late follow-up. The contractions were recorded at an average reservoir capacity of 270 ml at early follow-up and 340 ml at late follow-up. The complication rate was high in the child group compared with that in adolescents. Of 13 patients with at least one reservoir complication 10 were from the child group. Nipple dysfunction (angled nipple, prolapsed or stenosed stoma) occurred in 35% of patients, stones in 40% and bleeding during catheterization in 15%. Revision was performed in 38% of the child group and 15% of the adolescents. Reservoir perforation was observed in two patients at 6 and 9 years postoperatively. At late follow-up continence was excellent in 17 of 19 patients and good in 2. We conclude that the Kock reservoir is a good modality for urinary diversion, but the complication incidence is high in the child group (<16 years). Stability of the reservoir in terms of volume and low internal pressures was achieved one year after operation, except in the patients with infrequent reservoir emptying. A time-related increase in the reservoir sensitivity and contractility was reported on enterocystometry. Nipple dysfunction is common during the first two years after surgery, particularly in the child group. Stones may form 3-4 years after surgery. Satisfactory continence was achieved in all patients, although a revisional operation was necessary in some patients in order to obtain permanent continence.
本研究的目的是评估因先天性尿失禁接受手术的儿童和青少年的科克储尿囊功能，并确定并发症发生率。通过膀胱测压、膀胱镜检查和患者病史对13名儿童（年龄范围10.8 - 16岁）和7名青少年（年龄范围16 - 18岁）的储尿囊功能进行了研究。对患者进行了3至10年的随访。随访报告分为术后早期（3个月至2年）和晚期（2至10年）。在早期随访中，4名患者的储尿囊容量高，其余患者正常。储尿囊压力低伴随着高容量和顺应性。在膀胱测压时，82%的患者在早期随访时体验到首次排空感觉，晚期随访时为92%。在早期随访中，60%的患者记录到储尿囊收缩，晚期随访时为65%。早期随访时收缩记录的平均储尿囊容量为270毫升，晚期随访时为340毫升。儿童组的并发症发生率高于青少年组。在13名至少有一项储尿囊并发症的患者中，10名来自儿童组。乳头功能障碍（乳头角度异常、脱垂或狭窄）发生在35%的患者中，结石发生在40%的患者中，插管时出血发生在15%的患者中。儿童组38%的患者和青少年组15%的患者进行了翻修手术。术后6年和9年分别有2名患者观察到储尿囊穿孔。在晚期随访中，19名患者中有17名控尿情况极佳，2名良好。我们得出结论，科克储尿囊是尿流改道的一种良好方式，但儿童组（<16岁）的并发症发生率较高。除了储尿囊排空不频繁的患者外，术后一年实现了储尿囊在容量和低内压方面的稳定性。膀胱测压报告了储尿囊敏感性和收缩性随时间的增加。乳头功能障碍在术后头两年很常见，尤其是在儿童组。结石可能在术后3至4年形成。所有患者均实现了满意的控尿，尽管为了获得永久性控尿，一些患者需要进行翻修手术。
