Experience with the Mainz modification of ureterosigmoidostomy

Area of Science:

• Urology
• Surgical Innovation
• Reconstructive Surgery

Background:

• Ureterosigmoidostomy, a historical urinary diversion technique, faced challenges with patient continence and bowel-related complications.
• The need for improved urinary diversion methods persists in managing bladder cancer and complex urological conditions.

Purpose of the Study:

• To evaluate the efficacy and safety of a modified ureterosigmoidostomy (rectosigmoid pouch; Mainz pouch II) as a low-pressure urinary diversion.
• To assess the functional outcomes, including continence and renal function, of this revived surgical approach.

Main Methods:

• A prospective study involving 34 patients (aged 1.9-76.9 years) undergoing modified ureterosigmoidostomy between 1992 and 1997.
• Indications included radical cystectomy for bladder cancer (30 patients) and benign conditions (4 patients).
• Standardized follow-up assessed continence, renal function, and acid-base balance.

Main Results:

• No perioperative deaths occurred. One patient required temporary nephrostomy for stent dislodgement.
• All patients achieved daytime continence; one experienced nocturnal incontinence.
• One case necessitated conversion to an ileal conduit due to sepsis; one nephrectomy was performed for obstruction. Mild hyperchloraemic acidosis was noted in two patients.

Conclusions:

• Detubularization of the rectum in the modified ureterosigmoidostomy effectively addresses bowel frequency and urge incontinence.
• The rectosigmoid pouch procedure is quick, safe, and yields satisfactory results, presenting a valuable option in reconstructive urology.