Outcome of Mainz II pouch urinary diversion after radical cystectomy in patients with muscle-invasive bladder cancer: our experience

Abstract

Introduction: Mainz II pouch urinary diversion in patients with muscle‑invasive bladder cancer is one of the options of continent urinary diversion following radical cystectomy (RC). We aim to report our experience and the outcome of our patients who had this procedure.

Patients and Methods: Patients who had RC and Mainz II pouch urinary diversion for muscle‑invasive bladder cancer in our institution from 2007 to 2016 were evaluated. Variables analyzed included age, gender, stage of the disease, pathological grade and tumor types, complications, and survival status.

Results: There were 11 patients who had Mainz II pouch urinary diversion after RC for bladder cancer over a 10‑year period. Four (36%) were male and 7 (64%) were female. The mean age of the patients was 58.6 (range, 52–65) years. The diseases were pT2, pT3, and pT4 in 2 (18%), 7 (64%), and 2 (18%) patients, respectively. Four (36%) had pelvic nodal metastasis. Nine (82%) had a histological diagnosis of transitional cell carcinoma, and two (18%) were squamous cell carcinoma (SCC). Ten (91%) patients had high‑grade disease, whereas only 1 (9%) patient had low‑grade disease. Short‑term morbidities were electrolytes derangement, hypokalemia, and acidosis in 2 (18%) patients and pyelonephritis in 2 (18%) patient. The two patients with invasive SCC had recurrence and death within 12 months of surgery. At present, four of the patients are alive, and seven are dead. Survival till date ranged from 8 to 120 months (mean survival time was 48 months). All patients achieved day and night time continence, and there was no significant long‑term morbidity from the method of urinary diversion.

Conclusion: Mainz II pouch urinary diversion is safe and acceptable to most of our patients with good long‑term results.

Keywords: Bladder cancer, Lagos, Mainz II pouch urinary diversion, Nigeria, outcome