IMR Press / EJGO / Volume 22 / Issue 1 / pii/2001118

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on as a courtesy and upon agreement with S.O.G.

Original Research

Preliminary experience with Mainz type II pouch in gynecologic oncology patients

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1 Gynecologic Oncology Unit, Department of Obstetrics & Gynecology, Ain Shams University,Cairo, Egypt
Eur. J. Gynaecol. Oncol. 2001, 22(1), 77–80;
Published: 10 February 2001

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 follow­up 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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