Modified Mainz pouch II urinary diversion and quality of life

Clinic of Urlogy, Clinical Center of Serbia, Belgrade.
Acta chirurgica iugoslavica 02/2007; 54(4):57-62. DOI: 10.2298/ACI0704057D
Source: DOAJ


The current referential literature describes over 40 surgical techniques of continent urinary derivations. A variation of ureterosigmoidostomy, published by Hadzi Djokic et al. (1996) is a combination of the original Mainz pouch II (sigma rectum pouch) technique (Fish & Hohenfellner, 1991) and modified ureterointestinal anastomosis as described by Camey & LeDuc (1979) with a few new details described by the author himself. In the period 1994-2006, the total of 236 patients were treated by this method. Radical cystectomy in cases of multifocal transitional cell carcinoma of the bladder was the most common indication for this method (91,5%). In the course of follow-up (mean duration 24 months) the quality of life (QL) of these patients was evaluated by physical characteristics, mental status, social aspects and comparative evaluation of quality of life with ileal conduit which is still considered the "gold standard" for urinary derivations. A very good quality of life in all studied dimensions (3/4) patients) suggests the fact that this form of continent urinary derivation provides the patients with the fair quality of life and confirms justifiability of this surgical procedure under certain indications.

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Available from: Nebojsa Ladjevic, Mar 04, 2014
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    • "Recently, many reports [16] [17] [18] [19] [20] showed that the Mainz pouch II was a safe and reproducible method of urinary diversion, and serves as a satisfactory method of continent urinary diversion in all age groups. We added a modification to the Mainz pouch II [21], the detubularised isolated ureterosigmoidostomy (DIUS), and reported a novel simple technique for ureteric reimplantation using a nipple technique [22]. "
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    ABSTRACT: Objectives To assess whether the detubularised isolated ureterosigmoidostomy (DIUS) technique is safe for urinary diversion after radical cystectomy. Patients and methods The study included 10 patients (mean age 61.8 years) with invasive bladder tumour, operated at the Alexandria University, Egypt. The diversion in all patients was through a DIUS, with ureteric reimplantation by an antirefluxing procedure, using an embedded-nipple technique. The patients were evaluated before and after surgery using radiological and manometric studies, and the results analysed statistically using Student’s t-test. Results Nine of the 10 patients could differentiate between urinary and stool sensation, and evacuate them separately. The mean (range) daytime frequency was 4.1 (3–5) and the mean night-time frequency was 0.5 (0–1). Before and after surgery, the respective mean resting anal pressure was 71 and 74 cmH2O (P = 0.004), the volume at first desire to defecate was 54 and 72 mL (P = 0.004) and the maximum tolerable volume was 140 and 160 mL (P < 0.001). The anorectal inhibitory reflex was lost in all patients after surgery. The mean (SD, range) basal pouch pressure was 5 (3.33, 0–10) cmH2O, and the end pressure was 13.2 (4.42, 9–20) cmH2O. Conclusion Although the Mainz II pouch has a documented efficacy for urinary diversion after radical cystectomy, the modifications we applied to the DIUS improved that method of diversion, by separating urine and stool evacuation, maintaining continence, and with a low frequency and better protection of the upper urinary tracts, resulting in an improvement in the patients’ quality of life.
    Arab Journal of Urology 09/2014; 12(3). DOI:10.1016/j.aju.2014.02.003