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Orthotopic MAINZ pouch bladder substitution - long-term follow-up.
Saskia Bröder1, Wolfgang Jäger1, Joachim W Thüroff2
1Department of Urology and Pediatric Urology, University Medical Center Mainz, Germany.
Central European Journal of Urology
|August 2, 2021
Summary
The MAINZ pouch orthotopic neobladder offers durable long-term continence and acceptable complication rates after radical cystectomy. This bladder substitution technique is a reliable option for urinary diversion, demonstrating long-term efficacy.
Area of Science:
- Urology
- Surgical Oncology
- Reconstructive Surgery
Background:
- Orthotopic neobladder is a surgical option for urinary diversion post-radical cystectomy.
- Long-term data are crucial for evaluating the efficacy of surgical interventions.
- This study assesses long-term outcomes of the orthotopic ileocecal (MAINZ pouch) bladder substitution.
Purpose of the Study:
- To evaluate long-term complications associated with the MAINZ pouch procedure.
- To determine long-term continence rates following orthotopic MAINZ pouch bladder substitution.
- To assess the overall durability and safety of the MAINZ pouch as an orthotopic diversion.
Main Methods:
- Retrospective analysis of 193 patients undergoing MAINZ pouch surgery between 1986 and 2011.
- Evaluation of surgical and medical follow-up records, supplemented by a recent questionnaire.
- Comparison of ureteral implantation techniques: submucosal tunnel (Goodwin-Hohenfellner), Wallace, and Nesbit.
Main Results:
- Median follow-up was 72 months in 183 patients; 38% mortality.
- Complications required surgical intervention in 13.5% (early) and 24.6% (late) of patients.
- Long-term continence: 84.8% completely continent, with low rates of stress incontinence (1.6% Grade I, 9.8% Grade II).
- Ureteral stenosis rates varied by technique: 13% (submucosal), 13% (Wallace), 3.6% (Nesbit).
Conclusions:
- The MAINZ pouch procedure demonstrates long-term continence rates comparable to other orthotopic bladder substitutions.
- Complication rates are acceptable and manageable over the long term.
- The orthotopic MAINZ pouch is a viable and time-tested option for urinary diversion after cystectomy.
