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Related Experiment Videos

The Mainz pouch II (sigma rectum pouch)

M Fisch1, R Wammack, S C Müller

  • 1Department of Urology, University of Mainz School of Medicine, Germany.

The Journal of Urology
|February 1, 1993
PubMed
Summary

This study introduces a novel low-pressure rectosigmoid reservoir for urinary diversion, avoiding extensive surgery. The technique effectively manages high-pressure bowel contractions, improving patient continence and protecting the upper urinary tract.

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Area of Science:

  • Urology
  • Surgical Innovation
  • Gastrointestinal Surgery

Background:

  • Urinary diversion often requires extensive bowel surgery, leading to complications.
  • Existing methods like ureterosigmoidostomy can fail, necessitating revision.
  • High-pressure bowel contractions pose a risk to urinary reservoirs.

Purpose of the Study:

  • To present a novel surgical technique for creating a low-pressure rectosigmoid urinary reservoir.
  • To evaluate the efficacy of this technique in achieving urinary continence and protecting the upper urinary tract.
  • To assess the applicability of this method for both primary urinary diversion and revision of failed procedures.

Main Methods:

  • Antimesenteric splitting of the rectosigmoid junction followed by side-to-side anastomosis.

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  • Detubularization of the bowel segment to create a low-pressure reservoir.
  • Fixation of the pouch at the promontory to minimize ureteral complications.

    • Main Results:

    • All 47 patients achieved daytime continence with a mean emptying frequency of 5 times daily.
    • Nocturnal continence was achieved in all but one patient, with a mean frequency of 1 episode.
    • Urodynamic evaluation confirmed low reservoir pressures (basal 24 cm H2O, peak 35 cm H2O), rendering bowel contractions ineffective.
    • The technique protected the upper urinary tract, even in cases with pre-existing dilatation.

    Conclusions:

    • The low-pressure rectosigmoid reservoir is an effective method for urinary diversion, obviating the need for extensive bowel surgery.
    • This technique enhances urinary continence and significantly reduces the risk of upper urinary tract damage.
    • It is a viable option for both primary urinary diversion and managing failures of previous ureterosigmoidostomy procedures.