Mainz Pouch II technique: 10 years’ experience

Abstract

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.

Clinical experience in a modified Roux‐Y‐ shaped sigmoid neobladder: assessment of complications and voiding patterns in 43 patients

“…The continence rate during the day after surgery in the present series was 100%, higher than after classic ureterosigmoidostomy [14,15], and consistent with other reports [8,16], confirming that the anal sphincter represents a very useful mechanism of continence. In patients with the Hautmann orthotopic ileal neobladder 95% were continent at 1 year after surgery during the day and 73% during the night.…”

“…In recent years, improved bowel preparation techniques, antibiotics and new absorbable suture materials have stimulated renewed interest in ureterosigmoidostomy. The sigma‐rectum pouch (Mainz pouch II), created by detubularizing the rectosigmoid colon, combines continent urinary diversion with a low‐pressure, high‐capacity reservoir, which reduces rates of complications such as uretero‐colonic anastomotic strictures, hyperchloraemic acidosis, recurrent pyelonephritis, and incontinence [7,8]. However, there is a high frequency of upper UTIs in patients with Mainz pouch II because of reflux of urine and feces.…”

Bladder exstrophy in adulthood

“…D'Elia et al . [11] reported on 26 patients with the exstrophy-epispadias complex who showed excellent continence rates with long-term upper tract preservation when compared with standard ureterosigmoidostomy.…”

Dilatation and curettage of urinary bladder: A rarity

“…Risk of carcinoma at the ureteral intestinal anastomosis is 5-13% during a 10-year period. [45] Hence, close monitoring of pouch by colonoscopy, especially after first 5 years should be done.…”