Complications of the Mainz Pouch II (Sigma Rectum Pouch)

Öbek, Can; Kural, Ali Rıza; Ataus, Süleyman; Coşkuner, Enis Rauf; Demi̇rkesen, Oktay; Çitçi, Arman; Önder, Ali Ulvi; Solok, Vural

doi:10.1159/000052437

Cited by 18 publications

(12 citation statements)

References 34 publications

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“…Hadzi-Djokic et al [28] reported a mean diurnal frequency of 4.2, with 21% of patients voiding more than six times during the day, while the mean nocturnal frequency was 2.1, with 27% of patients voiding 3–6 times and 5% voiding more than six times at night. That high rate was consistent with the findings from other series [26,30,31] . The present results can be also explained by the rectal detubularisation interrupting the local myenteric nerve plexus that is responsible for the integrity of the anorectal inhibitory reflex (in turn responsible for the defecatory urge), resulting in loss of that reflex.…”

Section: Discussionsupporting

confidence: 93%

Detubularised isolated ureterosigmoidostomy (Atta pouch): Manometric and radiological studies in a sample of patients

Atta

Boules

Kotb

2014

Arab Journal of Urology

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ObjectivesTo assess whether the detubularised isolated ureterosigmoidostomy (DIUS) technique is safe for urinary diversion after radical cystectomy.Patients and methodsThe study included 10 patients (mean age 61.8 years) with invasive bladder tumour, operated at the Alexandria University, Egypt. The diversion in all patients was through a DIUS, with ureteric reimplantation by an antirefluxing procedure, using an embedded-nipple technique. The patients were evaluated before and after surgery using radiological and manometric studies, and the results analysed statistically using Student’s t-test.ResultsNine of the 10 patients could differentiate between urinary and stool sensation, and evacuate them separately. The mean (range) daytime frequency was 4.1 (3–5) and the mean night-time frequency was 0.5 (0–1). Before and after surgery, the respective mean resting anal pressure was 71 and 74 cmH2O (P = 0.004), the volume at first desire to defecate was 54 and 72 mL (P = 0.004) and the maximum tolerable volume was 140 and 160 mL (P < 0.001). The anorectal inhibitory reflex was lost in all patients after surgery. The mean (SD, range) basal pouch pressure was 5 (3.33, 0–10) cmH2O, and the end pressure was 13.2 (4.42, 9–20) cmH2O.ConclusionAlthough the Mainz II pouch has a documented efficacy for urinary diversion after radical cystectomy, the modifications we applied to the DIUS improved that method of diversion, by separating urine and stool evacuation, maintaining continence, and with a low frequency and better protection of the upper urinary tracts, resulting in an improvement in the patients’ quality of life.

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Section: Discussionsupporting

confidence: 93%

Detubularised isolated ureterosigmoidostomy (Atta pouch): Manometric and radiological studies in a sample of patients

Atta

Boules

Kotb

2014

Arab Journal of Urology

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“…Late complications (metabolic acidosis, upper urinary dilatation and pyelonephritis) in our study were 2.6%, 6% and 3.5% respectively compared to other studies El-Mekresh et al [9]; (0%, 5.3% and 3.5%), Gerhaz et al [10]; (5.8%, 2.9% and 2.9%), Obek et al [11]; (6%, 5% and 8%) and Omaya [12]; (4.7%, 9.5% and 4.7%). In this study only 2 (1.7%) female patients had persistent night incontinence in comparison to other studies El-Mekresh et al [9]; 4 (7%), Gerhaz et al [10]; 1 (2.9%), Obek et al [11]; 1 (1.6%) and Omaya [12]; 1 (4.7%). Recently, it became evident that most of these complications are essentially due to high-pressure within the intact sigmoid colon and rectum.…”

Section: Discussioncontrasting

confidence: 48%

“…Many studies were evaluating results and its complications of ureterosigmoidostomy and its modifications. In our study early complications were presented in 23 (20%) patients while in other studies El-Mekresh et al [9]; 8 (14%), Gerhaz et al [10]; 4 (11.7%), Obek et al [11]; 2 (3.3%) and Omaya [12]; 6 (28.6%). Late complications (metabolic acidosis, upper urinary dilatation and pyelonephritis) in our study were 2.6%, 6% and 3.5% respectively compared to other studies El-Mekresh et al [9]; (0%, 5.3% and 3.5%), Gerhaz et al [10]; (5.8%, 2.9% and 2.9%), Obek et al [11]; (6%, 5% and 8%) and Omaya [12]; (4.7%, 9.5% and 4.7%).…”

Section: Discussionsupporting

confidence: 45%

“…In our study early complications were presented in 23 (20%) patients while in other studies El-Mekresh et al [9]; 8 (14%), Gerhaz et al [10]; 4 (11.7%), Obek et al [11]; 2 (3.3%) and Omaya [12]; 6 (28.6%). Late complications (metabolic acidosis, upper urinary dilatation and pyelonephritis) in our study were 2.6%, 6% and 3.5% respectively compared to other studies El-Mekresh et al [9]; (0%, 5.3% and 3.5%), Gerhaz et al [10]; (5.8%, 2.9% and 2.9%), Obek et al [11]; (6%, 5% and 8%) and Omaya [12]; (4.7%, 9.5% and 4.7%). In this study only 2 (1.7%) female patients had persistent night incontinence in comparison to other studies El-Mekresh et al [9]; 4 (7%), Gerhaz et al [10]; 1 (2.9%), Obek et al [11]; 1 (1.6%) and Omaya [12]; 1 (4.7%).…”

Section: Discussionsupporting

confidence: 45%

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New Look on Ureterocolic Diversion with Adjuvant Radiotherapy; SECI (South Egypt Cancer Institute) Experience

Ahmed¹,

Aboeleuon²,

Abdel-Rahim³

et al. 2018

JCT

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Background: Ureterosigmoidostomy was the first form of continent urinary diversion and had broad popularity during the first half of the 20th century. Primary enthusiasm was followed by disappointment when serious problems such as pyelonephritis, electrolyte imbalance, renal calculi and renal function deterioration become evident. In the 1950s these life threatening complications led to avoid this urinary diversion in favor of uretro-intestinal conduits. Objectives: Our aim was to evaluate our experience in ureterocolic shunt after radical cystectomy for bladder cancer. Methodology: This study was conducted in surgical oncology department, South Egypt cancer institute, Assiut university; in the period from January 2012 to January 2017 and including 115 patients (75 males & 40 females). Results: This is retrospective study including 115 patients (75 males & 40 females). Operative time was 130 minutes ranging between 2 to 2.5 hours. Average blood loss was 450 ml. After removal of rectal tube all patients were continent except 15 patients who were improved after 1-3 days. Within a month 12 patients had night incontinence and 5 patients had day time incontinence. After that day and night continence gradually improved in all patients except two females who had persistent night soiling and was in need for night time rectal tube. Conclusion: Ureterosigmoidostomy regains the interest of surgical oncology and urologist because of its simplicity and absence of appliance as many patients refusing cutaneous stoma and others are not suitable for orthotopic substitutes.

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“…Several studies have demonstrated that sigma-rectum pouch is a safe and acceptable procedure for urinary diversion, with high continence rates and a low incidence of complications (10,11). Nevertheless, nocturnal urinary incontinence, retrograde renal pelvis infection, ureteral-intestinal anastomotic stenosis, hyperchloremic metabolic acidosis, hypokalemia and impaired renal function are common complications occurring as a result of this procedure (12–15).…”

Section: Discussionmentioning

confidence: 99%

Urinary undiversion from a sigma-rectum pouch to a cutaneous urinary stoma as a treatment for severe metabolic disorders post-radical cystectomy: A case report

Shen

Liao

et al. 2019

Exp Ther Med

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A total of six male patients, who had undergone radical cystectomy and sigma-rectum pouch surgery due to bladder cancer (2–5 years previously), developed hyperchloremic metabolic acidosis, hypokalemia and renal dysfunction. The patients underwent urinary undiversion surgery (the pouch was isolated from the intestinal tract, abdominal ostomy was performed, and the sigmoid colon and rectum were reconnected) and blood gas and electrolyte analysis and renal function were compared pre- and post-surgery. Blood hydrocarbonate levels significantly improved 3 months post-surgery compared with the preoperative levels (17.90±4.12 vs. 7.57±4.25; P=0.026). At 6 months post-surgery, blood pH (7.36±0.04 vs. 7.16±0.08; P=0.028) and potassium levels (3.95±0.38 vs. 3.12±0.21; P=0.032) were found to have improved significantly compared with the pre-surgery levels, and remained normal. Serum creatinine levels decreased significantly from the preoperative levels at 6 months post-surgery (213.00±44.85 vs. 304.67±55.58; P=0.028). Serum chlorine (99.17±2.75 vs. 110.90±4.38; P=0.038) significantly improved until 3 years post-surgery. The results of this case report indicated that urinary undiversion from a sigma-rectum pouch to a cutaneous urinary stoma that separates the pouch and intestine may be a beneficial treatment for post-sigma-rectum pouch surgery acidosis and electrolyte disturbances.

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Complications of the Mainz Pouch II (Sigma Rectum Pouch)

Cited by 18 publications

References 34 publications

Detubularised isolated ureterosigmoidostomy (Atta pouch): Manometric and radiological studies in a sample of patients

Detubularised isolated ureterosigmoidostomy (Atta pouch): Manometric and radiological studies in a sample of patients

New Look on Ureterocolic Diversion with Adjuvant Radiotherapy; SECI (South Egypt Cancer Institute) Experience

Urinary undiversion from a sigma-rectum pouch to a cutaneous urinary stoma as a treatment for severe metabolic disorders post-radical cystectomy: A case report

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