Sigma rectum pouch for urinary diversion

Abstract

To investigate the clinical outcome of sigma rectum pouch as a continent form of urinary diversion. The clinical data of 38 patients, 32 males and 7 females, aged 53.2 (42 - 68) with muscle-invading bladder carcinoma who underwent a Mainz pouch II procedure after radical cystectomy 1996 - 2001 were analyzed. The intestine was incised over a length of 20 - 24 cm with the junction of sigmoid colon and rectum as the midpoint so as to create a low-pressure reservoir for urine and side-to-side anastomosis was performed on the posterior borders of the rectosigmoid wall. Submucosal tunnel technique was employed in antireflux urethral implantation. The patients were followed up for 7 - 60 months with a mean of 30 months postoperatively. Continence has been achieved in all the 38 patients with a micturition frequency of 3 - 5 times during daytime and 0 - 3 times at night. The mean volume of pouch was 515.6 ml (400 - 650 ml). The basal intra-reservoir pressure was 8 - 23 cm H(2)O (mean 16.5 cm H(2)O, 1 cm H(2)O = 0.098 kPa), the highest peak pressure was 12 - 33 cm H(2)O (mean 21.3 cm H(2)O). A modified sigmoid rectal pouch procedure provides a reservoir with a higher capacity and lower pressure without a reflux to the upper urinary tract and descending colon with lower incidence of complication, it is also a better alternative diversion procedure that would be easily accepted by surgeons and patients.