Okada Y, Shichiri Y, Terai A, Kakehi Y, Terachi T, Arai Y, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
Int J Urol. 1996 Sep;3(5):334-9. doi: 10.1111/j.1442-2042.1996.tb00549.x.
Continent urinary diversion (CUD) is performed on patients after total cystourethrectomy due to invasive bladder cancer or other diseases requiring urinary diversion. Since 1984, we have performed CUD using either the Kock pouch procedure or a modified Indiana pouch method. During the long-term follow-up, increasing numbers of late complications occurred, especially after the Kock pouch procedure. We summarized the frequency of postoperative complications, their management, and outcome of CUD using these 2 methods.
Between 1984 and 1995, CUD using the Kock pouch method was performed on 102 patients, and on 61 patients using the Indiana pouch method, with a mean follow-up period of 83 and 50 months, respectively. The patients were between 24 and 82 years old, with a mean age of 59 years. In most patients, the Kock pouch was constructed according to the original method, except for the use of a Dacron fabric collar, and the Indiana pouch was made using the ileal patch method.
Of 95 patients followed up for more than 3 months after CUD using the Kock pouch method, efferent and afferent nipple valve malfunction occurred in 21 (22%) and 26 (27%) patients, respectively. Efferent complications occurred during the first year after surgery, whereas afferent complications occurred several years after surgery. Open repair surgery (excluding ileus) was necessary for 36 (38%) patients. Of 59 patients followed for more than 3 months after CUD using the Indiana pouch method, 7 patients with stomal stenosis, 2 patients with stomal prolapse, and 1 patient with stricture at the ureterocolonic anastomosis were treated surgically. An hourglass-like deformity of the pouch was seen in 2 patients, on whom the original Indiana pouch method was performed. As a whole, 13 patients (22%) were retreated with open surgery. Urinary calculi occurred in 42 (44%) patients after CUD using the Kock pouch method and in 11 patients (19%) using the Indiana pouch method. The outcome was excellent, good, fair, and poor in 31, 37, 24, and 8% of the patients after CUD using the Kock pouch method, and in 36, 17, 42, and 5% of the patients after CUD using the Indiana pouch method.
We performed CUD using either the Kock pouch or the Indiana pouch method with a success rate of approximately 90%. The rates of revision, reoperation and stone formation were higher with the Kock pouch procedure than with the Indiana pouch procedure, while varying degrees of incomplete incontinence and difficulty in catheterization were seen more often in the latter.
可控性尿流改道术（CUD）适用于因浸润性膀胱癌或其他需要尿流改道的疾病而接受全膀胱尿道切除术的患者。自1984年以来，我们采用考克袋术或改良印第安纳袋法进行CUD。在长期随访中，晚期并发症的数量不断增加，尤其是考克袋术后。我们总结了使用这两种方法进行CUD的术后并发症发生率、处理方法及结果。
1984年至1995年间，102例患者采用考克袋法进行CUD，61例患者采用印第安纳袋法，平均随访时间分别为83个月和50个月。患者年龄在24至82岁之间，平均年龄59岁。大多数患者中，考克袋按原方法构建，仅使用了涤纶织物套环，印第安纳袋采用回肠补片法制作。
在采用考克袋法进行CUD后随访超过3个月的95例患者中，分别有21例（22%）和26例（27%）出现输出道和输入道乳头瓣功能障碍。输出道并发症发生在术后第一年，而输入道并发症发生在术后数年。36例（38%）患者需要进行开放修复手术（不包括肠梗阻）。在采用印第安纳袋法进行CUD后随访超过3个月的59例患者中，7例出现造口狭窄、2例出现造口脱垂、1例输尿管结肠吻合口狭窄患者接受了手术治疗。2例采用原印第安纳袋法的患者出现袋状沙漏样畸形。总体而言，13例（22%）患者接受了再次开放手术。考克袋法进行CUD后42例（44%）患者发生尿路结石，印第安纳袋法为11例（19%）。采用考克袋法进行CUD后，患者结局为优、良、中、差的分别占31%、37%、24%和8%；采用印第安纳袋法进行CUD后，上述比例分别为36%、17%、42%和5%。
我们采用考克袋或印第安纳袋法进行CUD，成功率约为90%。考克袋术的翻修率、再次手术率和结石形成率高于印第安纳袋术，而后者更常出现不同程度的不完全性尿失禁和导尿困难。
