Mainz Pouch II technique: 10 years' experience

Area of Science:

• Urology
• Surgical Oncology
• Reconstructive Surgery

Background:

• Urinary diversion is necessary for various conditions including bladder cancer and congenital abnormalities.
• Traditional ureterosigmoidostomy can lead to complications such as upper tract deterioration and poor continence.
• The Mainz Pouch II procedure was developed to improve outcomes in patients requiring continent urinary diversion.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of the Mainz Pouch II ureterosigmoidostomy.
• To assess continence rates, upper urinary tract preservation, and complication rates associated with the procedure.

Main Methods:

• A retrospective analysis of 123 patients who underwent the Mainz Pouch II procedure between 1990 and 2000.
• Indications included bladder cancer (92), bladder exstrophy/epispadias (26), urethral loss (4), and cloacal malformation (1).
• 102 patients with over 12 months of follow-up (mean 46.2 months) were included in the analysis.

Main Results:

• High rates of day-time (97%) and night-time (95%) continence were achieved.
• Ureteric implantation stenosis occurred in 7.2% of units, successfully treated with open repair or balloon dilation.
• Metabolic disturbances, primarily hyperchloraemic acidosis, were managed with oral alkalinizing agents in 69% of patients, with no clinically evident acidosis.

Conclusions:

• The Mainz Pouch II procedure, utilizing detubularization and specific ureteric implantation techniques, provides superior continence and upper tract protection compared to classical ureterosigmoidostomy.
• The technique is simple, reliable, and a viable option for continent urinary diversion in selected patient populations.
• Long-term results demonstrate the procedure's effectiveness in preserving renal function and achieving patient satisfaction.