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Simplified orthotopic ileocecal pouch (Mainz pouch) for bladder substitution
M El-Mekresh1, L Franzaring, M Wöhr
1Department of Urology and Pediatric Urology, Johannes Gutenberg University Mainz, Germany. elmekresh@mailcity.com
Objective:
To report operative modifications that render construction of the orthotopic Mainz pouch more simple, namely formation of the pouch using absorbable staples and utilization of the ileocecal valve as an antireflux mechanism.
Patients And Methods:
Between January 2001 and May 2002 out of 92 cystectomy cases, 21 patients (20 males and 1 female) underwent a simplified orthotopic Mainz pouch. The ureters were implanted via Wallace or Nesbit technique in the supravalvular portion of the ileocecal valve. The mean (range) age was 58 (43 - 74) years and the mean follow-up is 11.6 months (range 1 - 27).
Results:
No staple-related complications were encountered. Four renal units (8.8 %) were dilated, one secondary to an impacted ureteral stone and three secondary to ureteral stenosis requiring reimplantation. At 6 months follow-up, 5 renal units showed reflux (11.1 %) but without any clinical symptoms. 86.5 % of patients void spontaneously without significant residual urine. Continence was achieved in 74 % of cases during day and in 74 % at night.
Conclusion:
The simplified Mainz pouch is a versatile form of continent urinary diversion. The use of absorbable staples has simplified the pouch creation and yields functional results which favorably compare with other pouch forms. The ileocecal valve serves as an anti-reflux-mechanism.