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

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.