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100 cases of Mainz pouch: continuing experience and evolution
J W Thüroff1, P Alken, H Riedmiller
1Department of Urology, Johannes Gutenberg University, Medical School, Mainz, Federal Republic of Germany.
The Journal of Urology
|August 1, 1988
Summary
The Mainz pouch, a surgical technique using bowel segments, offers effective urinary reservoir creation. Modifications have improved continence rates for bladder augmentation, substitution, and diversion, with most patients achieving dryness.
Area of Science:
- Urology
- Surgical Techniques
- Reconstructive Surgery
Background:
- The Mainz pouch is a surgical technique for creating a urinary reservoir using segments of the cecum, ascending colon, and ileum.
- Initial applications included bladder augmentation and continent urinary diversion.
- Indications have expanded to include complete bladder substitution following radical cystoprostatectomy.
Purpose of the Study:
- To evaluate the efficacy and outcomes of the Mainz pouch procedure for various urological reconstructive needs.
- To assess the technique's success in bladder augmentation, total bladder substitution, and continent urinary diversion.
- To report on patient continence, functional results, and complications, including modifications to address initial issues.
Main Methods:
- The Mainz pouch procedure involves using 10-15 cm of cecum and ascending colon, plus two ileal loops of similar length.
- Modifications were made to the continence nipple technique for cosmetic stomal site (umbilicus) utilization.
- A total of 100 patients underwent the procedure between 1983 and the study period.
Main Results:
- In bladder augmentation (34 patients), 32 achieved complete dryness; 3 required intermittent catheterization.
- In bladder substitution (15 patients), most achieved daytime dryness, with some nighttime leakage managed by condom urinals.
- In continent urinary diversion (51 patients), all but 2 achieved dryness, with 2 requiring intermittent catheterization. Nipple prolapse was resolved by staple fixation.
Conclusions:
- The Mainz pouch is a versatile and effective technique for urinary reservoir creation, offering good to excellent continence.
- Surgical modifications have successfully addressed complications like nipple prolapse, enhancing functional outcomes.
- The procedure provides a reliable option for patients requiring bladder augmentation, substitution, or continent urinary diversion.