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Robotic Mainz II pouch for restoring continence and volitional voiding in failed exstrophy-epispadias complex.

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This study presents a robotic-assisted Mainz II continent urinary diversion for two patients with bladder exstrophy-epispadias complex. The procedure successfully restored urinary continence and preserved renal function in both patients.

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Area of Science:

  • Urology
  • Pediatric Surgery
  • Minimally Invasive Surgery

Background:

  • Bladder exstrophy-epispadias complex (BEEC) presents significant reconstructive challenges.
  • Failed primary repair in BEEC can lead to chronic urinary issues like leakage.
  • Adult patients with BEEC often seek alternatives to stomas and intermittent catheterization.

Purpose of the Study:

  • To evaluate the efficacy of the Mainz II continent urinary diversion in adult patients with BEEC.
  • To assess the feasibility of robotic assistance for this complex reconstructive procedure.
  • To determine the functional outcomes, including continence and renal function, post-diversion.

Main Methods:

  • Robotic-assisted Mainz II continent urinary diversion was performed in two patients (17-year-old male, 30-year-old female) with BEEC and failed primary repair.
  • Ureters were implanted into a sigmoid pouch using an extramural serosal tunnel for anti-reflux.
  • Patients had a history of continuous urinary leakage and open bladder plate.

Main Results:

  • Both patients achieved complete urinary continence at 3-month follow-up.
  • Patients could hold urine for 3-4 hours.
  • Renal function was preserved in both individuals.
  • The male patient maintained erectile function.

Conclusions:

  • Robotic-assisted Mainz II continent urinary diversion is a viable and effective option for adult patients with BEEC and failed primary repairs.
  • This technique offers a solution to avoid stomas and catheterization, improving quality of life.
  • The procedure demonstrates excellent functional outcomes regarding continence, renal preservation, and sexual function.