EXPERIENCE WITH THE MAINZ MODIFICATION OF URETEROSIGMOIDOSTOMY

Background The purpose of this study was to report experience with the revived surgical concept of ureterosigmoidostomy in its low pressure modification and to discuss its value within the current spectrum of u rinary diversion. Methods Between February 1992 and September 1997 mod ified ureterosigmoidostomy (rectosigmoid pouch; Mainz pouch II) was pe t-formed in 34 patients aged 1.9-76.9 (mean 55.8) years as a primary u rinary diversion after radical cystectomy for bladder cancer (n = 30) and benign conditions (bladder exstrophy, three patients; intractable urinary incontinence, one). All patients were followed prospectively a ccording to a standard protocol including assessment of continence, re nal function and acid-base balance. Results There were no perioperativ e deaths. In one patient dislocation of a ureteral stent in the early postoperative course required insertion of a percutaneous nephrostomy. All patients were continent during the day. One patient experienced n ight-time incontinence bur rejected a conversion procedure. In one cas e ureterosigmoidostomy was replaced by an ileal conduit after several episodes of septicaemia. One nephrectomy was performed for ureterointe stinal obstruction. Mild hyperchloraemic acidosis was seen in two pati ents. Conclusion Bowel frequency and urge incontinence, the major weak nesses of classical ureterosigmoidostomy, can be overcome by detubular ization of the rectum. As the modified procedure is quick, safe and ea sy to perform with highly satisfactory results, the rectosigmoid pouch has potential in reconstructive urology.