Name of the Procedure:

Continent Diversion with Intestine Anastomosis (Kock Pouch or Camey Enterocystoplasty)

Summary

Continent diversion is a surgical procedure that creates an internal reservoir from segments of the small or large intestine to store urine and allow controlled elimination through a stoma. This allows the patient to manage waste elimination without an external bag.

Purpose

This procedure addresses severe bladder dysfunction, bladder removal (cystectomy), or congenital conditions affecting urinary storage and elimination. The goal is to provide patients with a reliable and continent method to store and eliminate urine.

Indications

• Bladder cancer requiring cystectomy
• Neurogenic bladder conditions
• Congenital abnormalities of the urinary system
• Severe intractable bladder dysfunction
• Certain cases of severe incontinence

Preparation

• Fasting for 12 hours before surgery
• Adjustment of medications as advised by the surgeon
• Pre-operative imaging tests such as CT scans or MRIs
• Blood tests and overall health assessment

Procedure Description

1. Anesthesia Administration: General anesthesia is given to ensure the patient is unconscious and pain-free.
2. Incision and Access: An incision is made in the abdomen to access the intestines.
3. Segment Selection: A segment of the small intestine (e.g., ileum) or large intestine is selected and isolated.
4. Reservoir Creation: The isolated intestinal segment is reshaped to form a pouch (Kock pouch) or a neobladder (Camey enterocystoplasty).
5. Anastomosis: The pouch is then connected to the ureters on one end and to a controlled stoma on the abdominal wall.
6. Closure: The abdominal incision is closed and the area is dressed.

Tools and Equipment:

• Surgical scalpel, scissors, forceps
• Sutures and staplers
• Anesthetic machine and medications

Duration

The procedure typically takes 4-6 hours.

Setting

This surgery is performed in a hospital's surgical department.

Personnel

• Surgeon specializing in urology
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Urinary leakage or incontinence
• Bowel obstruction or adhesion
• Complications related to anesthesia
• Electrolyte imbalance

Benefits

• Provides a bladder substitute for effective urine storage
• Eliminates the need for an external urine collection bag
• Enhances quality of life by improving body image and convenience

Recovery

• Hospital stay for 7-10 days post-surgery
• Pain management with prescribed medications
• Gradual return to a normal diet
• Avoidance of heavy lifting or strenuous activity for 4-6 weeks
• Follow-up appointments to monitor recovery and function of the pouch

Alternatives

• Ileal conduit (urostomy)
• Orthotopic neobladder
• Medical management of symptoms with drugs and behavioral therapies

Pros and Cons:

• Kock Pouch/Camey Enterocystoplasty: Offers continence but is a longer, more complex surgery
• Ileal Conduit: Less complex but requires an external bag
• Orthotopic Neobladder: Similar benefits but may not be suitable for all patients

Patient Experience

During the procedure, the patient will be under general anesthesia and will not experience any sensation. Post-operatively, the patient might feel discomfort or pain, which will be managed with medications. There will be a period of adjustment and learning to use the new urinary reservoir, with instructions and support provided by the healthcare team. Regular follow-ups are crucial to ensure proper healing and function.