THE HEMI-KOCK ILEOCYSTOPLASTY - A VERSATILE PROCEDURE IN RECONSTRUCTIVE UROLOGY

The hemi-Kock system, constructed from approximately 40 cm. of terminal ileum, comprises a detubularized and remodeled ileal plate with a stapled ileoileal intussusception to form a 1-way valve. This system has been applied to reconstruct 30 varied cases in which the intussuscepted valve was used either for reflux prevention or as a continent stoma. The patients included 11 with intractable urinary incontinence and a devastated bladder outlet in whom the hemi-Kock pouch was anastomosed to the bladder after the bladder neck had been surgically closed, with the afferent limb of the nipple valve being routed through the abdominal wall as a continent stoma. In 9 patients who had previously undergone supravesical diversion, undiversion was accomplished with this system to augment the bladder, with the antireflux nipple being anastomosed to the prior ileal loop or ureters. In 5 patients in whom intractable bladder hyperactivity had led to devastated upper tracts with markedly dilated ureters this system was used for bladder augmentation, with the ureters being reimplanted into the afferent limb of the hemi-Kock system to prevent reflux. The final patients were those in whom the hemi-Kock pouch was converted into a complete reservoir and used for orthotopic bladder replacement. The hemi-Kock system proved to be successful in each of these roles. It created a capacious low pressure reservoir, protected the upper tracts from reflux and improved those that were previously dilated, and it proved to be a reliable continent stoma when applied to that use. The versatility of the hemi-Kock system in its application to a variety of reconstructive endeavors recommends it for use.