URETEROSIGMOIDOSTOMY WITH THE FORMATION OF LOW PRESSURE RESERVOIR: HISTORY OR OPERATION OF CHOICE? 15 YEARS OF EXPERIENCE

Aim: To examine the long-term outcomes of Mainz Pouch II ureterosigmoidostomy with the formation of a submucosal and extramural by Hassan (Hassan Abol-Enein) tunnels. Materials and methods. Mainz Pouch II ureterosigmoidostomies with the formation a submucosal tunnel (open-end technique) comprised group 1 (n=17) and with the formation of extramural ureteral implantation by Hassan - group 2 (n=15). The mean age of patients was 58±6.0 years, ranging from 16 to 76 years; among them there were 22 (68.8%) men and 10 (31.2%) women. Average follow-up was 14.7±6.0 years. All patients were continent during the daytime and at nighttime. Reservoir-ureteral reflux was detected in 2.4% (5 RU) observations and the obstruction only 1.4% (2 RU). Chronic pyelonephritis in the postoperative period was observed in 3 (9.75%) patients, whereas before surgery in 20 (62.5%) patients. The both modifications of the operation did not impair renal secretory function postoperatively in the majority of patients; in 2 of them its improvement was noted. Two patients experienced a decrease in the renal secretory function due to inadequate formation of extramural anastomosis. Conclusion: Mainz Pouch II and Hassan operations enable maintaining normal urination, optimize antireflux protection and are technically simple, provided the indications are carefully observed. The low incidence of complications of ureterosigmoidostomy, both in the immediate and in the long term implies that these operations may be the method of choice for continent bladder replacement in selected patients.

continent intestinal bladder replacement, ureterosigmoidostomy with the formation of low-pressure reservoir, reconstructive urology, extramural ureteral implantation, Mainz Pouch II, Hassan technique