THE SIGMOIDORECTAL POUCH (MAINZ POUCH-II)

A sigmoidorectal pouch was constructed in 20 patients(18 with invasive bladder cancer, 2 with complete urethral destruction with multiple ve sicovaginal fistulas). The rectal-dynamic studies showed that by detub ularization and reconfiguration of the sigmoid colon and rectum, we ob tained a low-pressure reservoir, with the high-pressure contractions e liminated. Preoperatively, the basal rectum pressure was 21.4 cm H2O; rectum contractions reached a mean of 27.6 cm H2O (maximum 48 cm H-2) Postoperatively (9-36 months) the mean basal pressure of the pouch was 19.3 cm H2O (p > 0.05; t test comparison with the preoperative value) , with a mean contraction value of 19.1 cm H2O (p < 0.05). All the pat ients experienced continence day and night with a pouch emptying frequ ency of four times during the day and once at night, after 9 months. B y fixing the pouch to the promontory or psoas muscle, without compromi sing the blood supply to the pouch, the risk of ureteral kinking and u pper urinary tract dilatation were considerably decreased. The price t o be paid for almost perfect continence was hyperchloremic acidosis in most patients.