Kock N G, Ghoneim M A, Lycke K G, Mahran M R
Institute of Urology and Nephrology, University of Mansoura, Egypt.
J Urol. 1989 May;141(5):1111-6. doi: 10.1016/s0022-5347(17)41185-2.
After cystoprostatectomy for cancer of the bladder 43 men were provided with a detubularized, low pressure ileal reservoir (Kock pouch) connected to the urethra. Reflux was prevented by an intussusception valve. There was no operative mortality and few early complications. At followup the mean postoperative observation time was 13 months, with a range of 5 to 20 months. Late complications included manifestations of local tumor recurrence or distant metastases in 9 patients within 6 months postoperatively, which made adequate functional evaluation impossible. In 18 patients reflux to the upper urinary tract due to eversion or sliding of the antireflux valve occurred at various postoperative intervals. In 16 of these patients incontinence developed as a consequence of the reflux. Surgical correction of the failing antireflux valve restored reflux prevention and continence. Within 3 to 6 months the capacity of the reservoirs had reached an ultimate volume of approximately 600 ml. Pressure waves exceeding 40 cm. water seldom occurred in the mature reservoirs and then only at high filling volumes. The mean urethral resting resistance to flow was 64 cm. water. The configuration and function of the upper urinary tract improved or stabilized postoperatively. Of 34 evaluable patients 30 were continent during the day with a voiding frequency of 3 to 5 times and dry at night with a frequency of 0 to 2.
43名男性因膀胱癌接受膀胱前列腺切除术后,被植入了一个去管化、低压的回肠储尿囊(科克袋),并与尿道相连。通过套叠瓣膜防止尿液反流。无手术死亡病例,早期并发症也很少。随访时,术后平均观察时间为13个月,范围为5至20个月。晚期并发症包括9例患者在术后6个月内出现局部肿瘤复发或远处转移的表现,这使得无法进行充分的功能评估。18例患者在术后不同时间段因抗反流瓣膜翻转或滑动出现上尿路反流。其中16例患者因反流出现尿失禁。对功能失效的抗反流瓣膜进行手术矫正后,恢复了防反流和控尿功能。3至6个月内,储尿囊的容量达到约600毫升的最终体积。成熟储尿囊中很少出现超过40厘米水柱的压力波,且仅在高充盈量时出现。尿道静息流阻平均为64厘米水柱。上尿路的形态和功能在术后得到改善或稳定。在34例可评估患者中,30例白天能自主排尿,排尿频率为3至5次,夜间干爽,频率为0至2次。