Abstract
Purposes
Our aim was to evaluate the anal sphincter function following cystectomy with urinary diversion of Mainz pouch II.
Methods
Seventy-six patients were involved in our survey, and the cohort was for two groups divided. The first group was a retrospective review of 40 patients with examination of the state of continence. Comparative examinations on anal sphincter function and the quality of life survey were carried out. The second group consisting of 15 patients underwent a prospective investigation including rectal manometry in both the pre- and postoperative periods. Measurements of resting anal sphincter pressure (RASP), maximal anal closing pressure (MACP) and the function of the recto anal inhibitions reflex were taken.
Results
In the first part of our investigation, 80% of the patients were considered as continent. There were no significant differences observed between RASP values in the cases of continent as well as of incontinent patients (79.2 ± 2 vs. 73.6 ± 68.4 mmHg, p = 0–53); however, the MACP values of the continent patients were significantly higher (204.3 ± 22.8 vs. 117.3 ± 14 mmHg, p = 0.001). In the course of the second experiment, both the RASP (86.3 ± 18.7 vs. 76.1 ± 13.9 mmHg p = 0.0049) and the MACP (232.2 ± 53.8 vs. 194.1 ± 74.5 mmHg, p = 0.0054) were detected as decreasing in the case of the incontinent group.
Conclusions
A decrease in rectal sphincter function is responsible for incontinence following Mainz pouch type II diversion, and this dysfunction can be correlated with the surgery. Ureterosigmoideostomy is therefore considered as a useful method of urinary diversion only in selected cases with proven good sphincter function.
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References
Simon J (1852) Ectropia vesicae (absence of the anterior walls of the bladder and pubis abdominal parietes), operation for directing the orifices of the ureters into the rectum, temporary success, subsequent death, autopsy. Lancet 2:568–570
Kock NG, Goheneim MA, Lycke MR, Mahran MR (1998) Urinary diversion to the augmented and valved rectum: preliminary results with a novel surgical procedure. J Urol 140(6):375–1379
Fish M, Hohenfellner R (1991) Der sigma rektum pouch: eine modifikation der harnleiterdarm implantation. Aktuelle Urol 22:1–9
Fisch M, Wammak R, Müller SC, Hohenfellner R (1993) The Mainz pouch II (sigma rectum pouch). J Urol 149(2):258–263
Pajor L, Zs Kelemen (1995) Our experience with the Mainz pouch II : 40 patients : follow up and complications. Ann Urolb 29(4):246–249
Pajor L, Romics I, Zs Kelemen, Frang D (1996) Mainz pouch II, a modified method of ureterosigmoidostomy. Orv Hetil 137(13):691–693
Pajor L, Romics I (1999) Modified ureterosigmoidostomy (Mainz II): technique and early results. BJU Int 83:157–158
Thüroff JW, Mattiasson A, Andersen JT, Hedlund H, Hinman FJR, Hohenfellner M, Mansson W, Mundy AR, Rowland RG, Steven K (1996) The standardization of terminology and assessment of functional characteristics of intestinal urinary reservoirs. BJU Int 78:516–523
Fayers PM (2001) Interpreting quality of life date: population-based reference date for the EORTC QLQ-C30. Eur J Cancer 37(11):1331–1334
Martelli H, Devroede G, Arhan P, Duguay C, Dornic C, Faverdin C (1978) Some parameters of large bowel motility in normal man. Gastroenterology 75(4):612–618
Fisch M, Wammack R, Hochenfellner R (1996) The sigma rectum pouch (Mainz pouch II). Word J Urol 14(2):68–72
Gilja I, Kovacic M, Mazuran B, Deban R (2000) Sigma–Rectum-Pouch, Klinische rektodynamische und radiologische. Untersuchung Akt Urol 31:169–173
Hadzi Djokic J, Tulic C, Dzamic Z, Acimovic M (1996) Sigma-rectum pouch (Mainz pouch II) preliminari rezultati. Urološki Archiv 18:137–145
Gumus E, Miroglu C, Saporta L, Basaran G, Horasanli K, Tanriverdi O, Karadag H (2000) Rectodynamic and radiological assesment in modified Mainz pouch II cases. Eur Urol 38:316–322
Philipson BM, Höckenström TH, Ackerlund S (1987) Biological consequences of exposing ileal mucosa to urine. World J Surg 11:790–797
Haadsem K, Dahlström JA, Ling L (1991) Anal sphincter competence in healthy women. Obstet Gynecol 78:823–827
Percy JP, Neill ME, Kandiah TK, Swash M (1982) A neurogenic factor in faecal incontinence in the elderly. Age Ageing 11:175–179
Bajory Z, Meszlényi I, Pajor L (2009) Artificial sphincter implantation for postoperative incontinency. Magy Urol 21:12–17
Gerharz EW, Köhl UN, Weingartner K et al (1998) Experience with the Mainz modification of ureterosigmoidostomy. Br J Surg 85:1512–1516
Ishigooka M, Hashimoto T, Izumya K, Sasagawa I, Nakada T (1993) Incidence of anal incontinence after long-term follow up of patients treated by ureterosigmoidostomy. Int Urol Nephrol 25:455–460
Nitkunan T, Leaver R, Tatel HRH, Woodhouse CRJ (2004) Modified ureterosigmoidostomy (Mainz II): a long-term follow up. BJU Int 93:1043–1047
Hiltunen K (1985) Anal manometric findings in patients with anal incontinence. Dis Colon Rectum 28:925–928
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M. Szűcs and A. Keszthelyi authors have equally contributed to this work.
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Szűcs, M., Keszthelyi, A., Szendrői, A. et al. Investigation of anal sphincter function following Mainz pouch type II urinary diversion after radical cystectomy. Int Urol Nephrol 44, 1013–1020 (2012). https://doi.org/10.1007/s11255-012-0142-z
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DOI: https://doi.org/10.1007/s11255-012-0142-z