Colon pouch (Mainz III) for continent urinary diversion

Abstract

Authors from Germany present data on the Mainz III pouch, where a colon segment is used. The results were very encouraging, with excellent continence rates. They suggest that this technique of continent urinary diversion should be considered as a suitable alternative to other methods. OBJECTIVE To evaluate the use of a continent cutaneous pouch made exclusively of colon (Mainz pouch III), as excellent results with the Mainz pouch III in irradiated patients suggested that the indication for this type of urinary diversion could be extended. PATIENTS AND METHODS The outcome of 24 patients with continent cutaneous urinary diversions using colon segments (Mainz pouch III) was investigated retrospectively. Overall, 22 of the patients had a malignant disease and two a benign disease; 16 had a hysterectomy and pelvic exenteration for gynaecological tumours; two men with a rhabdomyosarcoma of the prostate had a radical cystoprostatectomy; one woman had pelvic exenteration for bladder cancer; one man had a simultaneous rectum resection due to infiltrating rectal cancer, and another a left nephrectomy with cystectomy for concomitant kidney and bladder tumour. Benign indications were hyper‐reflexive bladder after polytrauma and two cases of neurogenic bladder dysfunction. Eighteen patients had radiotherapy (32–48 Gy) before the urinary diversion. RESULTS The mean (range) follow‐up was 35 (12–65) months. The mean pouch capacity was 293.8 mL. Three patients died during the follow‐up (two from disease progression and one suicide); 20 patients were fully continent, four with reduced pouch capacity (<300 mL) had slight incontinence and are wearing a protective pad (band‐aid at the umbilicus). All patients use intermittent self‐catheterization (mean catheterization frequency 6.8/day, range 6–12). Complications related to the pouch were one outlet stenosis that required revision. Postoperative pouchograms showed asymptomatic reflux in four patients. None of the patients developed metabolic acidosis or diarrhoea. CONCLUSIONS The Mainz pouch III is an alternative to other types of continent urinary diversion

Current developments for pelvic exenteration in gynecologic oncology

“…In Mainz III pouch, the operation is in the upper abdomen and nonirradiated segments of bowel can be used to create a pouch. Beside, ureters can be cut at a high level (out of the irradiation field) ensuring an excellent capillary blood supply and reducing the risk of complications at the implantation site [22 ].…”

Comparative Analysis of Secretory and Reabsorbing Activity of Ileal and Sigmoid Mucosa, Employed for Urinary Bladder Intestinoplasty

“…One authors report higher frequency after ileoplasty, and others believe that frequency is higher after using the colon [5,7,11,12]. Discrepancy in data can be explained by the fact, that the intensity of metabolic disorders is affected by several factors, e.g.…”

Evaluation and treatment of female stress urinary incontinence after pelvic radiotherapy

“…Ideally the bowel segment selected for the pouch should be outside of the radiotherapy field to improve tissue healing, reduce fibrosis, and improve continence. In a series by Stolzenburg of 24 patients undergoing Colon Mainz pouch III, the authors report a mean pouch capacity of 294 mL at a mean follow‐up of 35 months, and 20 patients were noted to be fully continent . In the 18 patients who were previously radiated, pouch capacity was noted to be adequate at 308 mL, which the authors attribute to the location of the ascending and transverse colon used for the pouch, located outside of the previously radiated field.…”

“…Literature reported since 2005 (where available). Reference list: Blaivas et al, Wilkin et al, Stolzenburg et al, Al Hussein Al Awamlh et al, Banerji et al…”