Initial results with slightly modified Kock pouch. My initial experience with 20 patients undergoing Kock pouch continent urinary diversion is reviewed. The procedure has been slightly modified from that described by Kock and Skinner. All patients have been followed for at least four months (median, 33 months). There have been no early complications related to the pouch. The most significant problem, incontinence, has occurred in 2 patients (10%) at three and four months, respectively, after surgery. Only 1 of these patients required temporary use of an external appliance. Leakage was due, in both cases, to a patulous efferent nipple valve. Both were repaired by plication of the nipple, and no new efferent limbs were constructed. In 1 patient (5%) prolapse of the afferent limb associated with reflux and pyelonephritis developed one year post-surgery. Stones have developed in 3 patients (15%). All patients are currently continent and stone-free, and all are pleased with the result. 