Sigma rectum pouch (Mainz II)

Bowel detubularisation is necessary to create a low pressure reservoir Sigma rectum pouch, applying this principle, was introduced in 1000 as evaluation of ureterosigmoidostomy (USS), in an attempt to avoid or reduce long term complications Creating a low pressure sigma tract, better continence and better upper tract protection was expected. From October 1991 we employed the sigma rectum pouch in 71 patients (pts.) with a median age of 63 years (range 38-74). The median follow-up was 26 months (range 3-60) Indications included cystcctomy for bladder cancer in 67 pts., bladder exstrophy in 1 pt., interstitial cystilis in 1 pt and failed USS in 2 pts. One pt died of pulmonaris embolism and one for urofecal fistula. Early complication (7%) included I case of bowel obstruction, 1 case of peritonitis due to an agranulocytosis and 3 cases of wound dehiscence. All the complications are not related to the procedure. Of 137 renal units, stenosis occurred in 4% of cases, 2 resolved with an endoscopie ballon dilatation and 4 with surgery. The functional results demonstrated a good continence (97%), no renal units lost or damaged and a pood mirturaling frequency (6 times per day). The Mainz pouch II. with the creation of low pressure reservoir in continuity with gastro-intestinal tract, utilising the anal sphincter for continence, is an attractive alternative to many forms of urinary diversion. Long term results will he necessary to confirm the favourable complications rate and fuctional results.