Urinary bladder exstrophy in a 21-year old female

A case of a 21-year-old female admitted for a hypogastric mass and inability to control her urination since childhood. Physical examination revealed an 8 x 7 cm reddish mass at the hypogastric area with intermittent jet of urine coming out from the inferolateral aspects of the mass. Diagnosis was urinary bladder exstrophy. Intravenous pyelography showed an outpouching mass at the anterior aspect of the pelvis with widening of the symphysis pubis and excretion of contrast medium into both upper urinary tracts but non-filling of contrast medium within the urinary bladder consistent with bladder exstrophy. Cystectomy performed with urinary diversion using the Mainz pouch with an appendiceal stoma and coverage of the abdominal defect with tensor fascia lata myocutaneous flap and rectus femoris muscle flap. On follow-up, patient was continent. (Author)

Augmentation Cystoplasty with Mainz Pouch in Tuberculous Contracted Bladder / 대한비뇨기과학회지

A variety of surgical techniques for augmentation cystoplasty have been developed. To evaluate the clinical availability of the augmentation cystoplasty using the Mainz pouch, We reviewed 8 patients with tuberculous contracted bladder who underwent construction of a Mainz pouch. Preoperative frequency was dramatically improved in all of 8 patients. Mean bladder capacity increased from 36 ml preoperatively to 534ml postoperatively. On the uroradiologic study, preoperative hydronephrosis was improved or stable in 9 of l0 renal units and was aggravated in 1 renal unit. Preoperative vesicoureteral reflux disappeared in all of 3 patients. Urodynamic study revealed mean residual urine of 70ml and maximal intravesical pressure during contraction of 65cmH2O after cystoplasty. There were no significant complications which required surgical revision.

Initial Experiences of 15 Cases of Mainz Pouch / 대한비뇨기과학회지

Since continent urinary diversion and bladder substitution after cystoprostatectomy have been offered as alternative to standard urinary diversion, increasing numbers of patients seek to avoid a wet stoma. So since 1988 we have used a pouch constructed from a combination of large and small bowel(Mainz pouch), which offers a low pressure reservoir of adequate capacity, antirefluxing ureteral reimplantation and continent reservoir. Initial applications of the Mainz pouch were for bladder augmentation after subtotal cystectomy and for continent urinary diversion. Current indications have been extended to complete bladder substitution after radical cystectomy with anastomosis of the pouch to the membranous urethra. A total or 15 patients underwent a Mainz pouch procedure ;6 for bladder augmentation, 8 for continent urinary diversion and 1 for total bladder substitution after radical cystectomy. All bladder augmentation cases, 4 of 8 diversion cases and substitution case are completely dry day and night. There are no significant perioperative morbidity and mortality.

Bladder Augmentation and Continent Diversion Using the Mainz Pouch (Mixed Augmentation Ileum and Cecum) / 대한비뇨기과학회지

The Mainz pouch offers a low pressure reservoir of adequate capacity, antirefluxing ureteral implantation and continent reservoir for bladder augmentation and continent diversion. Reconstruction of a urinary reservoir using a Mainz pouch was performed on 2 patients in 1987. The Mainz pouch was used for bladder augmentation in one patient and for continent urinary diversion in other one. The operative technique and clinical results are described.