The Mainz Pouch II (Sigma Rectum Pouch)

Abstract

A low pressure rectosigmoid reservoir for urine is created obviating the need for colostomy, augmentation or extensive bowel surgery. Antimesenteric splitting of the intestine at the rectosigmoid junction and subsequent side-to-side anastomosis are performed. Urodynamic data demonstrate that the detubularization is effective in rendering high pressure bowel contractions ineffective. Without the risk of damaging the mesentery the pouch is fixed at the promontory, which lessens the risk of ureteral kinking and upper urinary tract dilatation. The technique is indicated not only in cases of failed ureterosigmoidostomy but also for primary urinary diversion. All 47 patients who underwent the operation were evaluable with a followup of 1 to 20 months (mean 10 months). All patients are continent during the daytime with a mean emptying frequency of 5 times. All but 1 elderly woman are dry at night with a mean frequency of 1 episode. With the reservoir full the basal pressure was 24 cm. water and the highest peak pressure recorded was 35 cm. water. The low pressure improves continence, protects the upper urinary tract and even allows dilated ureters to be implanted.

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

“…In comparison with other series [5,9,12] there was no serious acidosis in the present study, while others reported a need for alkalinizing agents in 51-65% of patients [4,9,10,12]. Pajor and Keleman [23] reported a need for oral medication in all their patients.…”

“…Incontinence after ureterosigmoidostomy is devastating for the patient; rectodynamic studies before surgery, as recommended by others [4,12], were not used in the present series, only the anal sphincter competence test. The complete continence rate during the day shows that rectodynamic investigations are unnecessary for predicting continence after surgery when the anal sphincter is used as a continence mechanism during urinary diversion.…”

“…Patients were prepared before surgery as described by Fisch et al [4]. Contraindications for the procedure were an incontinent anal sphincter, sigma diverticulosis, intestinal polyps, previous or planned radiotherapy, and insufficient renal function (serum creatinine > 1.5 mg/mL).…”

“…The Mainz Pouch II urinary diversion was created as described by Fisch et al [4]. For ureteric implantation three different techniques were used: Goodwin-Hohenfellner (GH) [14,15], Abol-Enein (AE) [16][17][18] and the Le-Duc methods [7], the choice being based on intraoperative findings and preoperative pyelocaliectasis.…”

“…Because there were many problems, many modifications were described, but the technique was abandoned [3]. A modification of the technique using sigma detubularization [4] improved the continence rate and the so-called Mainz Pouch II procedure became an alternative technique of urinary diversion [4][5][6]. Ongoing problems include ureteric stenosis at the ureterosigmoidal junction [7][8][9], the need for oral akalinizing agents [4,5,8,[10][11][12] and the development of secondary malignancies at the ureteric implantation site [13].…”