Bladder substitution with ileocaecal (Mainz) pouch. Clinical performance over 2 years.

A series of 11 patients underwent ileocaecal bladder substitution (Mainz pouch) with urethral anastomosis after radical cystectomy and pelvic lymphadenectomy for moderate to high grade transitional cell carcinoma of the bladder. With 12 to 27 months of follow-up (mean 18), 6 patients are voiding and are dry day and night with timed voidings; 4 patients continue intermittent catheterisation because of inability to perform the Valsalva manoeuvre adequately, and 1 has a suprapubic tube because of stricture of the enterourethral anastomosis. Upper tract studies revealed dilation of 4 of 22 renal units and 1 patient required endourological intervention. Serum electrolyte studies revealed slightly elevated chloride levels in 6, mild hypocarbia in 3, and reduced vitamin B12 levels in all patients, but no megaloblastic anaemia. The Mainz pouch appears to have very satisfactory short- and intermediate-term results.