Modified ureterosigmoidostomy (Mainz II): a long-term follow-up.
OBJECTIVE
To assess the long-term results in patients treated using a modified ureterosigmoidostomy (Mainz II).


METHODS
Between 1994 and 1999, 17 patients had their lower urinary tract reconstructed by a ureterosigmoidostomy, modified by reconfiguring the rectum to make a low-pressure reservoir (Mainz II). All patients were followed on a standard protocol. Data were extracted from the database and from a review of the case-notes. In 12 patients the procedure was with a radical cystectomy for carcinoma. Five had a failed conventional ureterosigmoidostomy for bladder exstrophy and therefore proceeded to a Mainz II. The data on continence and complications were retrieved for a retrospective analysis; the mean (range) follow-up was 6.4 (4-8.6) years.


RESULTS
Ten of those with bladder cancer and one in the revision group were continent. Two patients in the revision group had sufficiently severe nocturnal incontinence to require conversion to a colonic conduit. Seven of the 17 patients had hyperchloraemic acidosis, one had pyelonephritis and one had renal stones. There were no anastomotic neoplasms.


CONCLUSIONS
The Mainz II has a good outcome if used as the primary procedure. In patients with an existing ureterosigmoidostomy who are incontinent, detubularization of the rectosigmoid alone is unlikely to restore continence.
Nitkunan
T
T
Institute of Urology, UCL London, UK.
Leaver
R
R
Patel
H R H
HR
Woodhouse
C R J
CR
D000328:Adult; D000368:Aged; D012809:Colon, Sigmoid / Q000601:surgery; D003125:Colostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014519:Ureterostomy / Q000379:methods*; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery