Preliminary experience with Mainz type II pouch in gynecologic oncology patients

Objective: To evaluate the Mainz low-pressure modification of ureterosigmoidostomy with extramural serous-lined ureterointestinal anastomosis as a method of urinary diversion in gynecologic patients undergoing anterior pelvic exenteration.

Materials & methods: Between December 1995 and September 1998, Mainz type II pouch was performed in 11 patients aged between 27-70 years (mean 58.5). Four were diagnosed with cervical cancer (2 stage IV A and 2 central recurrences following radical hysterectomy done elsewhere), two with stage III bilharzial bladder cancer, two with urethral cancer (one stage III and one recurrent following surgery done elsewhere), one with stage IV A endometrial cancer, one with stage IV A vaginal cancer complicating long standing incarcerated total procidentia and lastly one patient with refractory obstetric vesicovaginal fistula with almost total loss of the upper urethra, bladder neck and base. All patients were followed closely and particular complications related to the diversion were recorded as acid-base imbalance, renal impairment and incontinence.

Results: The pouch construction with anterior exenteration took an average of 242 min (150-330). There were two postoperative deaths due to pulmonary embolism and pneumonia both being related to the precarious condition of the patients and not to the diversionary procedure. The follow-up ranged between 25-60 months, with a mean of 43.5 months for the surviving patients. During that time period, four deaths occurred due to cancer recurrence. Otherwise, all patients remained continent during the day with one patient being incontinent at night. Two patients developed one attack of pyelonephritis and were treated successfully with antibiotics. No hyperchloremic acidosis and no hydronephrotic changes were seen in any patient and renal function remained normal.

Conclusion: Mainz type II pouch with extramural serous-lined ureterointestinal anastomosis is a safe promising quick and easy method of urinary diversion for patients undergoing anterior pelvic exenteration and having an intact anal sphincter. Longer follow-up and a greater number of patients will be needed to compare it with other forms of urinary diversion.

Anterior exenteration; Urinary diversion; Mainz type II pouch

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