Mainz II Pouch: A Simple Continent Urinary Diversion after Cystectomy

Purpose: The type of urinary diversion after radical cystectomies for bladder cancer does not influence survival substantially, but it may influence the quality of life very much. The aim of this study was to asses the Mainz II (sigma pouch) as a new modification of uretrosigmoidostomy in our patients in comparison to the more commonly used rectal bladder diversion. Material and Methods: Twenty one patients, 10 females and 11 males, with invasive bladder cancer in 18 and carcinoma of cervix uteri in 3 were operated upon by radical cystoprostatectomy or anterior pelvic excentration during the period from 1999 to 2001. Detubularized rectosigmoid pouch with sub-mucosal tunneling ureterocolic implantation was used. This group was compared to 31 patients with bladder cancer treated at the same time period by cystectomy, rectal bladder diversion and terminal iliac colostomy. Results: All 21 patients were continent day and night except one case who had night soiling for 2 months. Six patients (28.6%) developed early post operative complications including 3 urinary leakages, 2 wound sepsis, one case of intestinal obstruction and a case of deep vein thrombosis (DVT). There was no postoperative mortality. Late complications (14.3%) were upper urinary dilatation in 2 patients (2/21), one severe metabolic acidosis and one pyelonephritis. The other group of patients showed more or less similar early and late complications (32.2% & 16%) but with persistent incontinence in 3 cases (9.6%). Conclusion: The sigma pouch urinary diversion is a simple technique with excellent continence rate and lower complication rate than the classic uretrosigmoidostomy. It is a good alternative to orthotopic bladder substitution when the urethra cannot be used. Late complications could be controlled by conservative treatment in most of the cases. Rectal bladder diversion has similar rate of late complications but with the addition of external colostomy and its specific complications.