A modified sigma-rectum pouch (Mainz pouch II) technique: analysis of outcomes and complications on 220 patients.
OBJECTIVE
To evaluate the safety and efficacy of a modified technique for a sigma-rectum pouch (Mainz pouch II).


METHODS
Between October 1994 and March 2003, a modified Mainz pouch II was constructed in 220 patients (153 men and 67 women, mean age 56.7 years) in a multicentre prospective study. The median follow-up (177 patients, 81%) was 21 (1-84) months.


RESULTS
There were no peri-operative deaths; there were early complications in 24 patients, including prolonged ileus in six, pyelonephritis in 17, unilateral ureterohydronephrosis in 11, bilateral ureterohydronephrosis in two, and incipient renal failure in five. Late complications included ureteric implantation-site stenosis (unilateral in eight patients and bilateral in three). In all, 92 patients (52%) needed oral alkalizing medications and potassium supplementation because of hyperchloraemic metabolic acidosis. All but three patients (99%) were continent by day and at night. The mean (sd) voiding frequency was 4.2 (1.6) voids by day and 2.1 (0.5) at night.


CONCLUSIONS
The Mainz pouch II is a simple and reproducible surgical technique, with good results in terms of mortality, morbidity, continence and overall quality of life. The main limitation is malignant transformation of the uretero-intestinal anastomosis. For selected cases, the technique is a good alternative to other types of continent urinary diversion.
Institute of Urology and Nephrology, Clinic of Urology, Belgrade, and Clinical Center Nis, Clinic of Urology, Nis, Serbia and Montenegro. jovanhdj@bitsyu.net
Jovan B
JB
Hadzi-Djokic
Dragoslav T
DT
Basic
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D012007:Rectum / Q000601:surgery*; D011795:Surveys and Questionnaires; D014525:Urethral Stricture / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000379:methods; D014719:Vesicovaginal Fistula / Q000601:surgery