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Rectodynamic and radiological assessment in modified mainz pouch II cases.
E Gumus1, C Miroglu, L Saporta
1Sisli Etfal Teaching Hospital 2nd Urology, Istanbul, Turkey. egumus@superonline.com
European Urology
|August 15, 2000
Summary
This study shows a modified sigmoidorectal pouch (Mainz pouch II) offers a larger capacity and lower pressure urinary diversion. This procedure is a viable alternative, particularly in Muslim countries, due to its religious compatibility.
Area of Science:
- Urology
- Surgical Innovation
- Radiology
Background:
- Radical cystectomy for muscle-invasive bladder tumor necessitates urinary diversion.
- The Mainz pouch II procedure is a modified sigmoidorectal pouch technique.
Purpose of the Study:
- To evaluate radiologic findings of the modified Mainz pouch II.
- To measure pressure changes within the modified Mainz pouch II.
Main Methods:
- 26 patients undergoing radical cystectomy received the Mainz pouch II.
- Radiologic imaging, sigmoidoscopy, and pressure/capacity measurements were performed pre- and post-operatively.
- 24-hour pouch pressure ('natural pouch pressure') was measured using a CVP manometer.
Main Results:
- Postoperative pouch capacity increased significantly to an average of 520 ml compared to 150 ml preoperatively.
- Sigmoidal colon pressure decreased from 20 cm H2O preoperatively to 6-6.5 cm H2O postoperatively.
- Average 24-hour natural pouch pressure was 8.7 cm H2O, rising to 13.8 cm H2O with the urge to defecate.
Conclusions:
- The modified Mainz pouch II provides a high-capacity, low-pressure urinary reservoir.
- It effectively prevents reflux and reduces metabolic acidosis.
- This procedure is a suitable alternative urinary diversion, respecting religious practices in Islamic countries.