Objective: To assess the early and late metabolic effects of urinary diversion in children and adolescents with a Kock urinary reservoir.
Patients and methods: Thirteen children (aged 10.8- 16 years) and seven adolescents (aged 16-18 years; 10 girls and 10 boys), underwent surgery for congenital urinary incontinence. They were followed for 3-10 years (mean 6.5), divided into an early (3 months to 2 years) and a late (2-10 years) period, and assessed for renal function and any metabolic effects.
Results: At the early and late follow-up, one of 19 and three of 16 patients, respectively, had metabolic acidosis. Hyperchloraemia was present in four of 20 patients at the early and in eight of 18 at the late follow-up. Serum creatinine was increased in four of 20 patients at the early and eight of 18 at the late follow-up. In patients with infrequent reservoir emptying (</=4 times/day), the serum creatinine level was increased in seven of 13 at the early and eight of 10 at the late follow-up (P<0.05). The glomerular filtration rate was below normal in four of 20 patients preoperatively, in six of 19 at the early and in eight of 18 at the late follow-up.
Conclusions: The continent ileal reservoir in children and adolescents produces similar changes to those previously reported in adults. However, almost all patients with metabolic disorders were younger than 16 years at operation. The pre-existing impairment of renal function, together with associated congenital anomalies, mental and/or physical disorders, young age, recurrent urinary tract infections and infrequent reservoir emptying, leads to deterioration in renal function after the Kock operation. Even with this risk, the Kock pouch remains a viable alternative to other forms of continent urinary diversion, because it has a wide calibre stoma, allowing large-bore catheters, and is therefore especially suitable for individuals with weak hand function, e.g. quadriplegic or meningomyelocele patients. However, as shown by these results, the child with a Kock pouch requires continuous medical attention.