Modified Mainz pouch II (Sigma Rectum pouch) urinary diversion: 12 years experience

To analyze the outcome of Mainz Pouch II urinary diversion related to complications and life quality.

From 1995 to 2006, a total of 67 patients (60 male and 7 female, mean age 58.4 years, range 48 to 70) who underwent modified ureterosigmoidostomy (Mainz Pouch II) procedure have been retrospectively analyzed. The mean follow-up was 18 (1 - 72) months and it was available for 56 patients (84%). Early and late postoperative complications as well as quality of life after surgery were analyzed. An clinical questionairre has been used for examination specific urinary diversion items.

Early postoperative complications (<30 days) we-re detected in 9 patients (13%) and late complications (>30 days) in 19 patients (28%). Early complications consisted of urine leakage of moderate degree in 5 (7%) and ileus requiring surgical revision in 4 (6%) patients. The late complications included acute pyelonephritis in 12 patients (18%) and uretero-sigmoidal anastomotic site stenosis in 7 (11%). Ureterosigmoidal anastomotic site stenosis was detected in 7 patients with 7 renoureteric units (RU). In 4 RU, metal Strecker stent was successfully applied. In 3 RU, permanent nephrostomy catheter was applied. Oral alkalizing agents were applied in 22 patients (33%) due to metabolic acidosis. Two patients died due to severe acidosis. Continent rate was 96%. The mean voiding frequency during the day and night was 5.2+/-1.8 and 2.7+/-0.5, respectively. Global life quality was bad for 3 (8%), acceptable for 15 (38%) and good for 22 (54%) patients.

The Mainz Pouch II urinary diversion is simple and safe procedure regarding complications rate, continence and quality of life. It is good alternative to other forms of continent urinary diversion. Patient selection and compliance following by meticulous follow-up are of utmost importance for successful operative outcome.