Colon pouch (Mainz III) for continent urinary diversion
Article first published online: 6 MAR 2007
Volume 99, Issue 6, pages 1473–1477, June 2007
How to Cite
Stolzenburg, J.-U., Schwalenberg, T., Liatsikos, E. N., Sakelaropoulos, G., Rödder, K., Hohenfellner, R. and Fisch, M. (2007), Colon pouch (Mainz III) for continent urinary diversion. BJU International, 99: 1473–1477. doi: 10.1111/j.1464-410X.2007.06767.x
- Issue published online: 6 MAR 2007
- Article first published online: 6 MAR 2007
- Accepted for publication 10 November 2006
- colonic pouch;
- urinary diversion;
Authors from Germany present data on the Mainz III pouch, where a colon segment is used. The results were very encouraging, with excellent continence rates. They suggest that this technique of continent urinary diversion should be considered as a suitable alternative to other methods.
To evaluate the use of a continent cutaneous pouch made exclusively of colon (Mainz pouch III), as excellent results with the Mainz pouch III in irradiated patients suggested that the indication for this type of urinary diversion could be extended.
PATIENTS AND METHODS
The outcome of 24 patients with continent cutaneous urinary diversions using colon segments (Mainz pouch III) was investigated retrospectively. Overall, 22 of the patients had a malignant disease and two a benign disease; 16 had a hysterectomy and pelvic exenteration for gynaecological tumours; two men with a rhabdomyosarcoma of the prostate had a radical cystoprostatectomy; one woman had pelvic exenteration for bladder cancer; one man had a simultaneous rectum resection due to infiltrating rectal cancer, and another a left nephrectomy with cystectomy for concomitant kidney and bladder tumour. Benign indications were hyper-reflexive bladder after polytrauma and two cases of neurogenic bladder dysfunction. Eighteen patients had radiotherapy (32–48 Gy) before the urinary diversion.
The mean (range) follow-up was 35 (12–65) months. The mean pouch capacity was 293.8 mL. Three patients died during the follow-up (two from disease progression and one suicide); 20 patients were fully continent, four with reduced pouch capacity (<300 mL) had slight incontinence and are wearing a protective pad (band-aid at the umbilicus). All patients use intermittent self-catheterization (mean catheterization frequency 6.8/day, range 6–12). Complications related to the pouch were one outlet stenosis that required revision. Postoperative pouchograms showed asymptomatic reflux in four patients. None of the patients developed metabolic acidosis or diarrhoea.
The Mainz pouch III is an alternative to other types of continent urinary diversion