Further Experience with the Modified Rectal Bladder (The Augmented and Valved Rectum) for Urine Diversion

Abstract

Continent diversion with the modified rectal bladder was done in 83 patients and 65 are currently evaluable with followup ranging from 6 to 36 months. There was no postoperative mortality and the morbidity rate was acceptable. Renal function and configuration were maintained in most patients (91%). Dessusception of the colorectal valve was observed in 7.6% of the patients. Evidence was provided that this valve is effective in prevention of regurgitation of the rectal contents to the proximal colon. All patients were continent during the day. Enuresis was noted in 6 patients and all of them responded to imipramine hydrochloride therapy. The results support earlier observations that the procedure offers distinct advantages over ureterosigmoidostomy and the simple rectal bladder.

Complications of the Mainz Pouch II (Sigma Rectum Pouch)

“…Koch et al [31]introduced the modified rectal bladder (the augmented and valved rectum) in which a colorectal intussusception valve prevents reflux of urine from the rectum to the proximal colon decreasing the surface area of urine in contact with the colon epithelium, and consequently the potential for reabsorption. In addition, patching with an open sheet of the ileum serves to improve the urodynamic qualities of the neoreservoir [32]. Using the same principles, Sundin and Mansi [33]constructed a low–pressure, large–capacity reservoir by detubularization and S configuration of the rectosigmoid, avoiding the need for patching with the ileum.…”

“…The early complication rate was as high as 21.5% with the modified rectal bladder technique. In addition, creation of an intussusception valve has its inherent complications [32]. A video–rectodynamic study of our patient illustrated reflux to the proximal colon after the infusion of 500 ml of contrast medium.…”

Continent Urinary Diversion Using the Mainz-Type Ureterosigmoidostomy –A Valuable Salvage Procedure

“…Various variants have been described including the use of intussusception of the sigmoid colon into the rectal pouch to contain the urine there more effectively [9]. This is unnecessary anyway for reasons already given and it is also unnecessarily complicated.…”

Conversion from colonic conduit into recto‐sigmoid pouch (Mainz pouch II)

“…Their mean (range) age at primary conduit diversion was 5.5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) years, the mean interval between conduit diversion and conversion into continent anal diversion 8 (4-18) years and the mean age at conversion into a Mainz pouch II was 13 (8-32) years. The characteristics of the patients are summarized in Table 1.…”

“…However, pitfalls of conduit diversion include stoma-related complications such as stoma stenosis and dermatitis, and renal deterioration from ureteric obstruction or reflux [3][4][5]. Due to developments in the field of continent urinary reservoirs in the past 20 years, continent cutaneous diversion [6][7][8] and continent anal diversion [9,10] Ureterosigmoidostomy represents the oldest form of continent urinary diversion [11], but it fell into disfavour due to complications such as pyelonephritis and renal function impairment, anal incontinence and metabolic acidosis. Peristaltic contractions of the sigmoid colon causing increased pressure were held responsible for anal incontinence and sigmoido-ureteric reflux.…”