Laparoscopic cystectomy and intracorporeal continent urinary diversion (Mainz II) in treatment for interstitial...

Interstitial cystitis (IC) is a difficult-to-manage chronic and insidious condition. We present a series of patients with IC who failed to respond to conservative treatment. The patients underwent total cystectomy with completely intracorporeally performed continent urinary diversion (Mainz II rectosigmoid pouch) as a radical alternative to the treatment of this condition.

Eight patients who fulfilled the clinical criteria for IC according to the National Institute of Health and in whom all previous conservative treatments had failed between January 2001 and April 2009 were operated on. A descriptive analysis was made with the following variables: age, surgical risk according to the American Society of Anesthesiology (ASA), total surgical time (ST), ST of the cystectomy, ST of the urinary diversion, early and late complications, time of hospital stay, bleeding and need of transfusion, specimen extraction pathway and uterine sparing.

Mean age was 54.25 (±17.8) years, total mean ST 286.4 (±44.8) minutes, mean ST of the cystectomy 86.2 (±25.6) minutes, mean ST of the diversion 123.7 (±28.6) minutes, mean bleeding 321.4 (±242.9) cc, mean time of hospital stay 8.3 (±1.3) days. Fifty percent were ASA I, 37.5% ASA II and 12.5% ASA III. A hysterectomy was made in 50% of the cases. In 5 cases (62.5%) the bladder was extracted through the rectum and in 3 cases (37.5%) through the vagina. The only early complication was urinary sepsis in one patient. There was no conversion in the series.

Total cystectomy with urethrectomy and intracorporeal continent urinary diversion is an effective and definitive alternative for the treatment of treatment resistant IC. Their technical difficulty and its learning curve limit their application to centers with an extensive experience in laparoscopy.