Kock Pouch for Urinary Diversion: Effective But No Longer Mainstream

When your bladder is no longer able to do its job, surgically constructed pouches can be a viable substitute. One of the earliest of these is known as the Kock pouch (pronounced “coke” pouch).

The bladder is an important organ in your body. Not only does it store urine and signal when it’s reached capacity, but it also has the ability to modify the amounts of water and other substances in that urine.

Like all organs in the body, sometimes the bladder experiences dysfunction. In serious conditions, like cancer, it may need to be fully or partially removed. When this happens, a new means of eliminating urine is necessary.

Creating a new pathway for your urine is known as urinary diversion, and the Kock pouch is one option your doctor might consider.

In 1964, Dr. Nils Kock introduced the Kock pouch, also known as the K-pouch, to the world of bladder health. It presented surgeons with a low-pressure bladder substitute that was later adapted for the removal of fecal waste.

The Kock pouch is a type of continent pouch, a pouch that acts as a replacement reservoir for your urine.

Continent pouches are made from a piece of your bowel. K-pouches traditionally use a section of the ileum, the end portion of the small intestine.

This pouch is attached internally to the wall of your abdomen and is accessible from the outside through a stoma, a valve that allows it to be manually drained. On the inside, the Kock pouch is connected to your ureters which allow urine to flow in from the kidneys through an internal valve system.

To empty the pouch when it’s full, you insert a reusable catheter through the stoma. This is typically done every 4 to 6 hours.

The type of urinary diversion procedure you have depends greatly on personal preference.

The Kock pouch and other continent pouches offer internal urine reservoirs for people who aren’t keen on the idea of having an external bag.

Your surgeon’s experience with continent pouches will also play a role in the decision, as will factors like your ability to use a catheter, the health of your bowels, and complications with other medical conditions.

Pros of using a continent pouch

• Continent pouches offer an internal option if you don’t want the hassle or aesthetics of an external bag known as an ostomy pouch.
• The stoma used for catheterization can be easily covered with an inconspicuous bandage.
• If you have good dexterity and are able to adhere to a regular routine of manual drainage, K-pouches and other continent pouches may serve you well.

Cons of continent pouches

• Compared to other urinary diversion procedures, continent pouch construction and assembly are complex and lengthy.
• The pouch doesn’t have the same abilities as a natural bladder. There’s no capacity to expand or contract and no nerve endings to let you know when it needs to be emptied.
• You may have to apply significant pressure to help express urine from the internal pouch, and it will be necessary to adhere to stringent hygiene practices and catheter cleaning to limit infection risk.

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The Kock pouch is no longer a commonly used continent pouch due to the complexity of the procedure and complications related to surgically creating its valve systems.

Its decline in popularity wasn’t because the K-pouch didn’t perform. In fact, it was known to have a large volume capacity and exceptional function. Since its creation in the 1960s, however, more options have become available that offer easier, less invasive means of urinary diversion.

The Indiana pouch, for example, is a next-generation continent pouch that is considered highly effective and easy to construct.

In general, continent urinary diversions are associated with an increased risk for many complications, including:

• urinary tract infections
• kidney infections
• incontinence from the stoma
• pouch inflammation (pouchitis)
• pouch rupture
• changes to the size and shape of the stoma
• bladder stones
• urethral strictures
• B12 deficiency
• sexual dysfunction

Kock pouch creation is classified as a urostomy procedure. It’s often part of a larger surgical process involving a cystectomy, where the bladder needs to be fully or partially removed.

This means your final cost can include both the urostomy and the cystectomy.

According to a 2019 systematic review, the average cystectomy utilizing continent pouch diversion costs approximately $22,000.

Urostomy alone, according to Medicare, costs an average of $3,660, but that cost is not specific to complex continent urinary diversion procedures.

How much of the procedure, follow-up care, and supplies are covered by insurance depends on your carrier and current policy. Due to the other urinary diversion options available, your insurance may push back on the decision to use a K-pouch over more modern options.

Cystectomy and urostomy are covered by Medicare insurance as medically necessary procedures. You may be eligible for up to 80% of coverage under this government program.

The Kock pouch was originally developed in the 1960s as an option for urinary diversion. It created an internal urine reservoir out of a piece of the small intestine that could be drained manually with a catheter.

While the Kock pouch was effective, modern urinary diversion procedures have replaced it as a first-line option for many surgeons.

Last medically reviewed on March 15, 2023