Mainz II and double folded rectosigmoid pouches. Experience with 95 patients

We report a clinical case series for construction of Mainz II or double folded rectosigmoid pouch with suitable antireflux uretero-intestinal anastomosis.

Ninety-five patients with invasive bladder carcinoma were treated by radical cystectomy and supravesical urinary shunt in form of either Mainz II {56 (58.9%)} or double folded {39 (41.1%)} rectosigmoid pouch. Antireflux techniques for uretero-intestinal anastomosis were subserosal extramural and submucosal tunnels for 122/190 (64.2%) dilated and 68/190 (45.8%) normal caliber ureters. All patients were kept on prophylactic alkalization. Evaluation included clinical, radiological, laboratory, and urodynamic evaluations. Mean follow-up was 40 months.

Early postoperative complications were reported in seven (7.4%) cases that were treated conservatively. All patients were continent day and night. Reflux was reported in 2/122 (1.6%) renal units (RU) with dilated ureters and in 1/68 (1.5%) RU with normal caliber ureter, that was managed conservatively. Stenosis at uretero-intestinal anastomosis was reported in 10 (5.3%) RU. Laboratory investigations were within normal. Pouchometry results were comparable in both Mainz II and double folded rectosigmoid pouches. Both were low-pressure good capacity reservoirs.

Mainz II pouch is indicated in cases of normal caliber, unilateral dilated, and some cases of bilateral dilated ureters, while double folded rectosigmoid pouch is optional in case of bilateral dilated ureters. Both have comparable low-pressure urodynamic features.