The Mainz Pouch (Mixed Augmentation Ileum and Cecum) for Bladder Augmentation and Continent Diversion

Thüroff, Joachim W.; Alken, P.; Riedmiller, H.; Engelmann, U.; Jacobi, G. H.; Hohenfellner, R.

doi:10.1016/s0022-5347(17)44714-8

Cited by 285 publications

(82 citation statements)

References 47 publications

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“…The incorporation of colon has the advantage of the use of a submucous tunnel for ureteroenteric anastomosis [2], while ileal neobladders try to achieve reflux prevention by other procedures such as the Le Duc technique [3] or newer modifications such as the Studer afferent loop [4]. The incidence of ureteroenteric anastomotic stenosis varies between 2 and 30% according to the surgical technique employed and the series studied.…”

Section: Surgical Complicationsmentioning

confidence: 99%

Follow-Up after Urinary Diversion

Fichtner¹

1999

Urol Int

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With modern forms of urinary diversion being widely employed during recent years, the awareness of possible complications and appropriate follow-up strategies gains rising importance and current follow-up strategies are reviewed herewith. Follow-up investigations after urinary diversion have to address possible surgical complications, metabolic changes as well as the risk of secondary malignancies in the incorporated bowel segments. The most important and possible deleterious surgical complication is upper tract dilation and obstruction following ureteroenteric anastomotic stenosis and occurs in 2–30% depending on the surgical technique and evaluated series. The most appropriate follow-up study to detect upper tract dilation is ultrasonography while the associated obstructional component can best be estimated by functional renographic studies (MAG₃ renal scan). The significance of reflux associated with urinary diversion remains controversial although experimental studies and clinical observations suggest a risk of renal functional deterioration associated with reflux which is certainly true in ureterosigmoidostomy following pyelonephritic changes. Possible metabolic changes include hyperchloremic metabolic acidosis and problems related to malabsorption due to bowel resection and incorporation of bowel segments into the urinary tract. The incidence of hyperchloremic acidosis is related to the form of urinary diversion, being higher in continent forms than in incontinent diversions, while hyperchloremic metabolic acidosis is most frequently encountered in ureterosigmoidostomy. While acute complications of metabolic acidosis may encompass hyperventilation as well as severe changes of serum electrolytes and acid base balance leading to cardiac arrhythmias necessitating immediate hospital treatment with intravenous alkalinizing, chronic acidosis may lead to osteopenia through hypocalcemia and stimulation of osteoclastic activity. Metabolic acidosis can be best detected by regular blood gas analysis. To prevent these complications prophylactic administration of alkalinizing agents (e.g. potassium citrate) should be readily performed. Malabsorption of bile acid strongly correlates with the length of ileum resected and can induce both chologenic diarrhea and malabsorption of liposoluble vitamins (A, D, E, K). Vitamin B₁₂ is exclusively absorbed in the distal ileum, serum levels therefore may be reduced following resection of distal ileum. This will not occur during the first 3–5 years following diversion because B₁₂ deposits usually will last for this period. Later, however, serum levels of vitamin B₁₂ should be checked annually while others favor routine substitution of this vitamin. The incidence of cancer occurring at the ureterointestinal anastomosis seems to be highest in patients with ureterosigmoidostomy varying between 2 and 29% with polypoid benign lesions being more frequent. The most common type of tumor is adenocarcinoma which has also been reported in colonic and...

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Section: Surgical Complicationsmentioning

confidence: 99%

Follow-Up after Urinary Diversion

Fichtner¹

1999

Urol Int

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“…Their mean (range) age at primary conduit diversion was 5.5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) years, the mean interval between conduit diversion and conversion into continent anal diversion 8 (4-18) years and the mean age at conversion into a Mainz pouch II was 13 (8-32) years. The characteristics of the patients are summarized in Table 1.…”

Section: Methodsmentioning

confidence: 99%

“…However, pitfalls of conduit diversion include stoma-related complications such as stoma stenosis and dermatitis, and renal deterioration from ureteric obstruction or reflux [3][4][5]. Due to developments in the field of continent urinary reservoirs in the past 20 years, continent cutaneous diversion [6][7][8] and continent anal diversion [9,10] Ureterosigmoidostomy represents the oldest form of continent urinary diversion [11], but it fell into disfavour due to complications such as pyelonephritis and renal function impairment, anal incontinence and metabolic acidosis. Peristaltic contractions of the sigmoid colon causing increased pressure were held responsible for anal incontinence and sigmoido-ureteric reflux.…”

Section: Introductionmentioning

confidence: 99%

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

Pahernik¹,

Wiesner²,

Gillitzer³

et al. 2005

BJU International

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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.

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“…The ureters are pulled through the tunnel and a neo-ostium made with 5 × 0 absorbable sutures. The ureteric adventitia is fixed at the external pouch wall with two 5 × 0 sutures [5].…”

Section: Figurementioning

confidence: 99%