Investigation of anal sphincter function following Mainz pouch type II urinary diversion after radical cystectomy

• Published in: International urology and nephrology 2012-08, Vol.44 (4), p.1013-1020
• Main Authors: Szűcs, M., Keszthelyi, A., Szendrői, A., Dombóvári, P., Majoros, A., Mavrogenis, S., Riesz, P., Keszthelyi, L., Asztalos, I., Romics, I.
• Format: Article
• Language: English
• Subjects: Anal Canal - physiopathology; Cystectomy; Fecal Incontinence - etiology; Fecal Incontinence - physiopathology; Female; Follow-Up Studies; Humans; Male; Manometry; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Postoperative Period; Pressure; Retrospective Studies; Urinary Bladder Neoplasms - surgery; Urinary Diversion - adverse effects; Urinary Diversion - methods; Urology; Urology – Original Paper
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-012-0142-z

Purposes Our aim was to evaluate the anal sphincter function following cystectomy with urinary diversion of Mainz pouch II. Methods Seventy-six patients were involved in our survey, and the cohort was for two groups divided. The first group was a retrospective review of 40 patients with examination of the state of continence. Comparative examinations on anal sphincter function and the quality of life survey were carried out. The second group consisting of 15 patients underwent a prospective investigation including rectal manometry in both the pre- and postoperative periods. Measurements of resting anal sphincter pressure (RASP), maximal anal closing pressure (MACP) and the function of the recto anal inhibitions reflex were taken. Results In the first part of our investigation, 80% of the patients were considered as continent. There were no significant differences observed between RASP values in the cases of continent as well as of incontinent patients (79.2 ± 2 vs. 73.6 ± 68.4 mmHg, p  = 0–53); however, the MACP values of the continent patients were significantly higher (204.3 ± 22.8 vs. 117.3 ± 14 mmHg, p  = 0.001). In the course of the second experiment, both the RASP (86.3 ± 18.7 vs. 76.1 ± 13.9 mmHg p  = 0.0049) and the MACP (232.2 ± 53.8 vs. 194.1 ± 74.5 mmHg, p  = 0.0054) were detected as decreasing in the case of the incontinent group. Conclusions A decrease in rectal sphincter function is responsible for incontinence following Mainz pouch type II diversion, and this dysfunction can be correlated with the surgery. Ureterosigmoideostomy is therefore considered as a useful method of urinary diversion only in selected cases with proven good sphincter function.