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

Abstract

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.

Modified ureterosigmoidostomy for management of malignant and non-malignant conditions

“…Eight point four per cent patients developed superficial wound sepsis which was managed conservatively, however 1.2% patient developed wound dehiscence requiring secondary suturing, and this is also comparable to other studies. Similarly, the 2.4% peri-operative deaths amongst the patients who had malignant disease is comparable to other series (11,12). We also observed the development 3.6% mucoceles among male patients with exstrophy after cystectomy and genitalplasty due to retention of prostatic secretions in bladder and urethral remnant tissues and this phenomenon required secondary surgery to remove the tissues at the same time to reconstruct communication with the external urethral meatus.…”

A modified sigma‐rectum pouch (Mainz pouch II) technique: analysis of outcomes and complications on 220 patients

“…The mean voiding frequency by day and at night was relatively high, as in other series [9,15,19,25], but questionnaire responses indicated that this had no major impact on the quality of life; before surgery, 58 patients (38%) had nocturia as a consequence of prostatism. Most patients reported that their interest and life volition, personal abilities, family relations, and overall quality of life were ‘very good’.…”

“…The incidence of stenosis is relatively low [14], and the success rate of the stenosis treatment in the present series was 86%. Other techniques of ureteric implantation after radical cystectomy are reported to have similar results [15].…”

Percutaneous Nephrolithotomy in a Patient with Mainz Pouch II Urinary Diversion: A Case Report

“…The rectosigmoid reservoir is a low pressure pouch providing continence, protection of the upper urinary tract and minimal morbidity (Bastian et al, 2004). Compared to other types of continent diversions, Mainz II results to notable decrease in mean and peak bowel contraction pressures, as confirmed in postoperative rectodynamic studies (Okhunov et al, 2011).…”