AB052. Modified ureterosigmoidostomy (Mainz Pouch II) urinary diversion: 10 years’ experience and follow-up

Objective: To report 10 years’ experience with Mainz Pouch II urinary diversion and to analyze its outcome.

Materials and Methods: From October 2004 to December 2014, 248 patients 205 men and 43 women (age range, 15 to 79 years, mean 59.85±10.76) had underwent Mainz Pouch II urinary diversion at 26 institutions in Gansu Province, China. The indications for urinary diversions were invasive urothelial carcinoma of the urinary bladder in 239 cases, squamous cell carcinoma of urethra in one and unoncological reasons in 8 cases. Clinical data and early complications were retrospective analysis. Data on long-term complications, continence behaviour, urinary frequency and patient’s assessment of the quality of life were investigated by follow-up.

Results: The median operative time for urinary diversion 120 minutes (range, 90-150 minutes), with a median estimated blood loss of 800 mL (range, 400-2,500 mL). Seven patients (2.82%) died in the perioperative period. Early complications were noticed in 66 patients (26.61%), such as intestinal fistula (6, 2.42%), pulmonary infection (5, 2.02%), ileus (4, 1.61%), pyelonephritis (4, 1.61%), deep venous thrombosis (2, 0.81%), pelvic infection (2, 0.81%), wound dehiscence (10, 4.03%), superficial wound infections (30, 12.10%), hemorrhagic shock (1, 0.40%), myocardial infarction (1, 0.40%) and rectovaginal fistula (1, 0.40%). Thirty-seven patients (n=241, 15.35%) were lost at follow-up and 204 patients were followed from 2 to 126 months (mean 47.93±29.26 months). Eighty-five (n=204, 41.67%) passed away. Late complications occurred in 29.41% of patients (60/204), including uretero-intestinal anastomotic stricture (20, 9.80%, 24 of 400 renoureteric units, 6.00%), recurrent pyelonephritis (12, 5.88%), prolonged ileus (11, 5.39%), metabolic acidosis (11, 5.39%), incisional hernia (5, 2.45%), pelvic infection (1, 0.49%).

Conclusions: Mainz Pouch II is a simple and easy to mastered form of continent urinary diversion, with excellent continence rate and good quality of life. When the patient refused to have a incontinent urinary diversion, it may be used as a convenient and satisfactory alternative for cystectomized patients who are not suitable for orthotopic urinary diversion due to bladder cancer invasion of prostate or urethra.

Keywords: Ureterosigmoidostomy; urinary diversion; Mainz Pouch II; surgical complications; follow up