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

Abstract

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.

Current Indications and Techniques for the Use of Bowel Segments in Pediatric Urinary Tract Reconstruction

“…Especially in those patients with a low or almost no compliance to CIC and/or medical therapy, a conduit is a temporary or a permanent solution. In children and adolescents, the colonic conduit has been shown to have less complications compared to the ileal conduit (113–124).…”