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

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.