Modified ureterosigmoidostomy (Mainz II)--technique and early results

To assess the surgical method and results at 3 months of ureterosigmoidostomy modified by reconfiguration of the rectum to make a low-pressure reservoir.

Over the last 8 years, patients undergoing lower urinary tract reconstruction have been followed using a written protocol; the data from patients undergoing a modified ureterosigmoidostomy were retrieved for a retrospective analysis. Two groups of patients were defined: in group A, 15 patients underwent cystectomy and diversion by modified ureterosigmoidostomy and in group B, four patients already had a conventional ureterosigmoidostomy which was incontinent, and the rectum was reconfigured to improve control. The incidence of complications and causes of incontinence were assessed.

The rectum was reconfigured by longitudinal incision and transverse closure in a 'U' fashion (Mainz II) in 17 patients, and augmented with ileum in two. There were no surgical complications. In group A all patients were continent at 3 months and in group B only two of four were continent; one patient in group A subsequently became incontinent. All incontinence was caused by chronic retention and overflow. There were no cases of pyelonephritis during follow-up to 29 months and no ureteric reflux was detected.

Modified ureterosigmoidostomy is a safe method of urinary diversion after cystectomy. A longer follow-up is needed to judge its place compared with other forms of diversion. It has a limited place in the management of incontinence in those with a longstanding conventional ureterosigmoidostomy.