Experience with a low-pressure colonic pouch (Mainz II) urinary diversion for irreparable vesicovaginal fistula and bladder extrophy in East Africa.

Abstract

Introduction and hypothesis: We report our experience with a low-pressure colonic pouch for urinary diversion in women with irreparable vesicovaginal fistulas and bladder extrophy.

Methods: This is a case series of 35 women with irreparable vesicovaginal fistula who underwent urinary diversion and two cases performed for bladder extrophy.

Results: Partial or complete loss of the urethra was present in over 90% of fistula cases. Fifty-five percent had prior vaginal repairs. The median length of stay was 21 days. Median follow-up for 29 (78%) patients was 18 months. Nighttime urinary incontinence occurred in 31%. Twenty-one (91%) of 23 patients had a serum creatinine <1.5 although all patients had evidence of acidosis. Two patients died 4 years after surgery from sepsis and renal failure.

Conclusions: Urinary diversion using the Mainz pouch II can be performed in the developing world with low perioperative morbidity and mortality. Acidosis and nighttime incontinence are the most common complications.