Modified ureterosigmoidostomy (Mainz Pouch II): a nonrefluxing stented vs unstented laparoscopic porcine model

Abstract

OBJECTIVE To describe a rapid and reproducible pure laparoscopic cystectomy and nonrefluxing modified continent urinary diversion (Mainz Pouch II), and to determine whether ureteric stenting decreases ureteric obstruction after surgery. MATERIALS AND METHODS After institutional review and approval, six female pigs (51–55 kg) had a laparoscopic cystectomy and urinary diversion using a modified Mainz Pouch II. Imbricating bowel over the extra‐intestinal ureteric segment created the nonrefluxing mechanism. All pigs had the same bowel preparation before a standard four‐port transperitoneal laparoscopic procedure, but three pigs received bilateral J ureteric stents and three did not. Body weights, radiographic imaging, serum electrolytes and renal function were monitored during the 6‐week survival period. RESULTS One stented pig developed bilateral pyelonephritis, renal obstruction and was killed. Including this pig, four of 12 renal units were obstructed, occurring more often in the stented pigs. There were no significant differences between the serum electrolytes before and after surgery or between the stented or unstented pigs. The surgery was quicker as experience increased. No pig developed hyperchloraemic metabolic acidosis. The nonrefluxing modification appeared to be effective, as reflux was only present in one renal unit. CONCLUSIONS Laparoscopic ureterosigmoidostomy, specifically the modified Mainz Pouch II, represents a viable and reasonable continent urinary diversion. The results suggest that there was no benefit in stenting in this pig model.

Current developments for pelvic exenteration in gynecologic oncology

“…Intracorporeal diversion has the advantages of decreased blood loss, improved convalescence, lower incidence of wound infection and incisional hernia, short recovery periods, rapid return of bowel function, better pain control, shorter hospitalization and improved cosmetics. Beside magnification, improved visualization permits a more accurate anastomosis technique, which may result in a decreased rate of postoperative strictures [16 ].…”

“…They have used staplers to create the neobladder from ileum and a Wallace type uretero-intestinal anastomosis by laparoscopy. Humphreys et al [16 ] proposed a technique of laparoscopic urinary diversion (modified Mainz II), which does not require bowel division and anastomosis. The performed Mainz II pouch has advantages over ureterosigmoidostomy, as stricture rate and metabolic disturbances rate is lower.…”