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The sigmoidorectal pouch (Mainz pouch II)

I Gilja1, M Kovacić, M Radej

  • 1Department of Urology, General Hospital Sveti Duh, Zagreb, Croatia.

European Urology
|January 1, 1996
PubMed
Summary

This study created a sigmoidorectal pouch for bladder cancer patients, achieving low-pressure reservoirs and excellent urinary continence. While effective, most patients developed hyperchloremic acidosis.

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Area of Science:

  • Urology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Invasive bladder cancer and urethral destruction necessitate urinary diversion.
  • Traditional methods may compromise reservoir function and patient continence.
  • Developing continent urinary diversion with low-pressure reservoirs is crucial.

Purpose of the Study:

  • To evaluate the efficacy of a sigmoidorectal pouch for urinary diversion.
  • To assess the functional characteristics of the constructed pouch.
  • To determine the impact on patient continence and potential complications.

Main Methods:

  • Sigmoidorectal pouch construction in 20 patients (18 with invasive bladder cancer, 2 with urethral destruction).
  • Rectal-dynamic studies to measure pouch pressure and contractions pre- and post-operatively.

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  • Assessment of ureteral kinking, upper urinary tract dilatation, and metabolic complications.

    • Main Results:

    • Detubularization and reconfiguration created a low-pressure reservoir, eliminating high-pressure contractions.
    • Postoperative pouch pressures (basal 19.3 cm H2O, contraction 19.1 cm H2O) were significantly reduced compared to preoperative rectal pressures.
    • All patients achieved day and night continence, with a 9-month functional adaptation.
    • Fixation to the promontory/psoas muscle reduced ureteral kinking and upper tract dilatation.
    • Hyperchloremic acidosis was observed in most patients.

    Conclusions:

    • Sigmoidorectal pouch construction is an effective method for urinary diversion, offering low-pressure reservoir function and excellent continence.
    • The technique minimizes risks of ureteral complications.
    • Hyperchloremic acidosis is a notable complication requiring monitoring.