Arai Y, Kawakita M, Terachi T, Oishi K, Okada Y, Takeuchi H, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
J Urol. 1993 Jul;150(1):51-5. doi: 10.1016/s0022-5347(17)35394-6.
Between 1984 and 1991, 115 consecutive patients underwent cutaneous continent urinary diversion comprising 76 Kock and 39 Indiana pouch procedures. The 2 different forms of achieving continent urinary diversion were subsequently compared in a long-term followup that evaluated complications, including pouch function and the need for revisions. In the Kock pouch group there were 14 (18.4%) early postoperative complications (3 months), which required 4 subsequent reoperations (5.3%). The Indiana pouch group had a similar incidence of early complications (17.9%) but there were no reservoir related problems. The long-term study group comprised 68 Kock and 37 Indiana pouch patients who were observed for 12 months or longer (mean followup 53 and 34 months, respectively). Of 9 efferent nipple valve malfunctions observed in the Kock pouch group 5 required surgical revision. Of 16 complications related to afferent limb function 15 were caused by the use of polyester fiber fabric for the anchoring collar and 8 of these 15 complications required surgical revision. The first 2 Indiana pouch patients had pouch deformities due to incomplete detubularization of the cecum that required surgical repair. Overall, surgical revisions, including minor repairs, were performed on 15 Kock pouch patients (22.1%) and 4 Indiana pouch patients (10.8%). Both forms of the procedure preserved continence to a satisfactory degree. Urinary tract stones developed in 18 patients (26.5%) from the Kock pouch group, usually on the exposed staples or the eroded, nonabsorbable collar used to construct the nipple valves. Stone formation was rare (5.4%) in the Indiana pouch group. The incidence of ureteral implantation stricture was low in both procedures. There was no significant difference in the incidence of bacteriuria between the 2 methods of urinary diversion. These data demonstrate that the Kock pouch and Indiana pouch procedures can be accomplished with the same early postoperative complication rate. Our 8-year experience showed a high incidence of Kock afferent nipple valve malfunction. However, most of these malfunctions were due to the use of a nonabsorbable collar and can be avoided. When taking this into account, therefore, it can be concluded that the Indiana pouch functions as well as the Kock pouch with roughly the same incidence of late complications and the same reoperation rate but with a lower incidence of stone formation.
1984年至1991年间，115例连续患者接受了皮肤可控性尿流改道术，其中包括76例Kock术式和39例印第安纳袋术式。随后，在一项长期随访中对这两种实现可控性尿流改道的不同方式进行了比较，该随访评估了并发症，包括储尿囊功能和修复需求。在Kock袋组中，有14例（18.4%）术后早期并发症（3个月内），这需要随后进行4次再次手术（5.3%）。印第安纳袋组的早期并发症发生率相似（17.9%），但没有与储尿囊相关的问题。长期研究组包括68例Kock袋患者和37例印第安纳袋患者，他们被观察了12个月或更长时间（平均随访时间分别为53个月和34个月）。在Kock袋组观察到的9例输出乳头瓣功能障碍中，5例需要手术修复。在16例与输入肠管功能相关的并发症中，15例是由于使用聚酯纤维织物制作固定环导致的，这15例并发症中的8例需要手术修复。最初的2例印第安纳袋患者因盲肠去管化不完全导致储尿囊畸形，需要手术修复。总体而言，包括小修复在内，15例Kock袋患者（22.1%）和4例印第安纳袋患者（10.8%）进行了手术修复。两种术式都将控尿维持在令人满意的程度。Kock袋组有18例患者（26.5%）发生尿路结石，通常发生在用于构建乳头瓣的外露吻合钉或腐蚀的不可吸收固定环处。印第安纳袋组结石形成很少见（5.4%）。两种尿流改道方法的输尿管植入狭窄发生率都很低。两种尿流改道方法的菌尿发生率没有显著差异。这些数据表明，Kock袋术式和印第安纳袋术式术后早期并发症发生率相同。我们8年的经验显示Kock输入乳头瓣功能障碍发生率很高。然而，这些功能障碍大多是由于使用了不可吸收固定环导致的，是可以避免的。因此，考虑到这一点，可以得出结论，印第安纳袋的功能与Kock袋相同，晚期并发症发生率和再次手术率大致相同，但结石形成发生率较低。
