Sigma-rectum-pouch: Clinical, rectodynamic and radiographic analysis

Purpose: The purpose of this study was to present functional characteristic s of the sigma-rectum-pouch (Mainz II). Patients and Methods: Between March 1991 and March 1999, the sigma-rectum-p ouch (Mainz II) was performed in 74 patients aged 33-82 (mean 58.6 years) a s a primary urinary diversion after radical cystectomy for bladder cancer ( n = 72) and benign conditions (n = 2). Preoperative and postoperative recto dynamic studies were performed in all of the 74 patients, whereas simultane ous postoperative rectodynamic studies and radiography were performed in 35 patients. Results: 3 patients (4.0%) died in the postoperative period due to multiple cortical abscesses of both kidneys followed by anuria and uremic syndromes (n = 2), while one patient died of pulmonary complications caused by an ex tensive pelvic abscess. In 5 (6.7%), a ureterocolonic stricture was noted. Deterioration of the upper urinary tract occurred in 8.7% of all renal unit s. Of the 74 patients 72 (97.3%), were continent day and night. Pressure in the sigma-rectum-pouch at capacity was 16.6 +/- 4.8 cm H2O, during voiding , contraction was 48.7 +/- 75.3 cm H2O. Simultaneous radiographic and recto dynamic studies confirmed that the sigma-rectum-pouch is truly a low pressu re reservoir capable of achieving appropriate capacity and emptying its con tents through the anal sphincter without reflux to the proximal colon. Conclusion: The sigma-rectum-pouch (Mainz II) is a true low pressure reserv oir, which achieves continence in the majority of patients both day and nig ht.