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OBJECTIVETo report the long-term results with the Mainz Pouch II procedure. PATIENTS AND METHODSBetween 1990 and 2000 a Mainz Pouch II ureterosigmoidostomy was used in 123 patients (49 females and 74 males, mean age 43.6 years, range: 1-73). The indications for urinary diversion were cystectomy for bladder cancer in 92 patients, bladder exstrophy and/ or incontinent epispadias in 26, irreparable traumatic loss of the sphincteric urethra in four and cloacal malformation (sinus urogenitalis) in one. In all, 102 patients with a follow-up of ≥ 12 months were evaluated (mean 46.2 months). RESULTSDay-and night-time continence rates were 97% and 95%, respectively. The remaining patients occasionally lose some drops of urine during coughing or straining, or reported minimal soiling of undergarments during the night. The mean voiding frequency was six during the day and once at night. There were 14 ureteric implantation stenoses (7.2% of 194 evaluated reno-ureteric units) and they were treated successfully by open repair (13) or antegrade balloon dilation (one). For metabolic disturbances, 69% of the patients had a capillary base excess of < -2.5 mmol/L and use oral alkalinizing drugs to prevent hyperchloraemic acidosis. There was no clinically evident metabolic acidosis. CONCLUSIONApplying the principles of detubularization and spherical reconfiguration to create a lowpressure reservoir and stratifying ureteric implantation between submucosal and serous-lined extramural tunnel techniques succeeded in giving better continence rates and long-term preservation of the upper urinary tract than a classical ureterosigmoidostomy. The Mainz Pouch II ureterosigmoidostomy is simple and reliable as a viable alternative for continent urinary diversion in selected patients.

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We present a novel radical cystectomy technique that allows bladder cancer control while maintaining urinary continence and reducing the risk of erectile dysfunction by sparing the prostatic capsule and the neurovascular bundles. Between September 1997 and December 2002, 85 men were candidates for cystectomy; 32 were selected for a prostatic capsule- and seminal-sparing cystectomy with orthotopic urinary diversion. All patients had clinical organ-confined bladder cancer (cT1 to cT3a). One patient died of unrelated causes. Of the remaining 31 patients, two with pT4, N+ disease underwent three cycles of adjuvant chemotherapy and are free of disease at 10 and 12 months postoperatively. Twenty-nine patients with organ-confined bladder cancer are free of disease after a mean follow-up of 32 months. At 24 months, 98% of the patients are completely continent during the day and 83% during the nighttime hours. In addition, 80% of the patients are able to complete sexual intercourse without auxiliary measures at a mean of 24 months postoperatively. Prostatic capsule- and nerve-sparing cystectomy permits en bloc removal of the bladder, of the adenomatous prostatic tissue, and of the seminal vesicles, thereby achieving local cancer control and preserving erectile function and urinary continence.