Modified ureterosigmoidostomy (Mainz II) — technique and early results

Woodhouse,; Christofides,

doi:10.1046/j.1464-410x.1998.00534.x

Cited by 22 publications

(14 citation statements)

References 15 publications

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“…In comparison with other series [5,9,12] there was no serious acidosis in the present study, while others reported a need for alkalinizing agents in 51-65% of patients [4,9,10,12]. Pajor and Keleman [23] reported a need for oral medication in all their patients.…”

Section: Discussioncontrasting

confidence: 43%

“…The lesser need for bicarbonate might be attributable to preoperative renal function and patient selection. Two smaller series with 29 patients together [5,11] reported no need for oral agents.…”

Section: Discussionmentioning

confidence: 97%

“…A modification of the technique using sigma detubularization [4] improved the continence rate and the so-called Mainz Pouch II procedure became an alternative technique of urinary diversion [4][5][6]. Ongoing problems include ureteric stenosis at the ureterosigmoidal junction [7][8][9], the need for oral akalinizing agents [4,5,8,[10][11][12] and the development of secondary malignancies at the ureteric implantation site [13]. It remains unclear whether decreasing anal sphincter function in elderly patients influences the continence rate in Mainz Pouch II urinary diversion.…”

Section: Introductionmentioning

confidence: 99%

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Modified ureterosigmoidostomy (Mainz Pouch II) in different age groups and with different techniques of ureteric implantation

et al. 2004

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OBJECTIVETo examine the outcome of Mainz Pouch II urinary diversion in different age groups and with different techniques of ureteric implantation. PATIENTS AND METHODSBetween March 1995 and August 2002 a Mainz Pouch II was created in 41 patients (27 male and 14 female, median age 56.3 years, range 2-75) with 81 renal units (RU). For analysis, the patients were divided into 29 (70%) aged < 65 years and 12 (30%) aged > 65 years. Ureteric implantation with the Goodwin-Hohenfellner (GH) technique was used in 55 RU, with the Abol-Enein (AE) modification in 23 and Le-Duc procedure in three. The median (range) follow-up (available for 36 patients, 88%) was 19 (1-80) months. An unvalidated questionnaire was used to determine specific urinary diversion items. RESULTSEarly complications occurred in 7% of patients, none requiring surgical intervention. Pyelonephritis occurred in five of 36 patients and seven of 71 RU (14% of the patients, 10% of the RU); all patients were < 65 years old. In five of seven RU pyelonephritis was caused by the development of upper urinary tract dilatation; none required surgical revision. Ureteric stenosis requiring reimplantation occurred in two RU (2%, one GH, one AE). All patients were continent in the daytime; all but one patient had to wake to urinate at night, with 36% having to do so more than six times. Of the patients, 63% were able to distinguish between stool and urine. Initially, alkalinizing drugs to prevent metabolic acidosis were taken by 30% of the patients. Of previously medicated patients with a follow-up of > 1 year, 8% required oral alkalinizing medication. CONCLUSIONThe Mainz Pouch II is a safe and reproducible urinary diversion, and serves as a satisfying alternative to other forms of continent urinary diversion in all age groups. The follow-up shows a low complication rate with good results in terms of continence. There were no significant differences in complication rates for the different ureteric implantation techniques. The long-term results remain to be evaluated.

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Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Modified ureterosigmoidostomy (Mainz Pouch II) in different age groups and with different techniques of ureteric implantation

et al. 2004

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“…Patients' satisfaction with this type of urinary diversion is usually high [14]. Independence from appliances such as external collecting devices and catheters favour this type of diversion from the patients' view.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Methodsmentioning

confidence: 99%

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

Pahernik¹,

Wiesner²,

Gillitzer³

et al. 2005

BJU International

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The Mainz Pouch II has now been used widely and found to be a valuable addition to the various types of urinary diversion. The authors from Mainz describe how a colonic conduit can be converted into a Mainz Pouch II, and the expected outcome from such a procedure. OBJECTIVE To report our long‐term results of conversion from conduit conversion into a continent anal urinary diversion, as after conduit urinary diversion in childhood, some patients wish to have a later conversion to a continent diversion to avoid external appliances and to improve their quality of life. PATIENTS AND METHODS Between 1992 and 2003, 139 patients had a urinary diversion with a recto‐sigmoid pouch (Mainz pouch II), of whom four had a conversion from a colonic conduit diversion to a recto‐sigmoid pouch. The mean (range) age at conduit diversion was 5.5 (3–14) years and the mean interval between conduit diversion and conversion to a continent anal diversion was 8 (4–18) years. The mean age at conversion into a Mainz pouch II was 13 (8–32) years and the follow‐up afterward was 11.5 (1–13) years. The conversion was done by incorporating the pre‐existing colonic conduit into the recto‐sigmoid pouch with no ureteric reimplantation. RESULTS There were no early complications; one nephrectomy was required 5 years after conversion because of uretero‐intestinal obstruction and pyelonephritis. All other reno‐ureteric units remained stable and renal function was maintained. All patients are continent day and night; three require substitution with alkali at a base excess of < −2.5 mmol/L to prevent hyperchloraemia and acidosis. CONCLUSION The recto‐sigmoid pouch is a therapeutic option when patients desire conversion from an incontinent type of urinary diversion to a continent type.

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