OUR EXPERIENCE WITH THE MAINZ-POUCH-II - 40 PATIENTS FOLLOW-UP AND COMPLICATIONS

Authors used the Mainz pouch II technique for urinary diversion in 40 patients suffering from bladder cancer. They made minor modifications to the original surgical technique: a longer. 40 cm bowel is detubular ized. the ureters are pulled through the mesosigma and embedded in a g roove of the bowel's mucosa, the sigma pouch is fixed to the dorsal pe ritoneum, a straight suture is used. Single-row on the dorsal wall and two-rows on the ventral wall. Within a few days after the surgery sut ure insufficiency occurred in the abdominal wall in 5 cases, in the bo wel in 2 cases. To treat suture disrupture of the bowel authors transf ormed the pouch, added a newly detubularized bowel segment to create a spheric rectum pouch and performed a definitive colostomy. During the follow-up period of six months to four years 8 of the 40 patients die d from bladder cancer, 2 from cardiac failure, 1 from pulmonary emboli sm, and 6 have had a recurrence of the tumor. In the 23 tumor free pat ients we found no reflux, one has a slight stenosis of the ureter, feb rile pyelonephritis did not occur, the pouch did not slip. the ureter had no kinking. and all patients are continent. Hyper-chloraemic acido sis has been prevented by regular administration of sodium bicarbonate or kalium citrate. Authors believe that Mainz pouch II is to be the m ost appropriate continent urinary diversion if an orthotopic substitut ion is not possible.