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Recto sigmoid pouch

A recto sigmoid pouch is when your back passage (rectum) is made into a pouch to collect urine like a bladder. After this surgery you pass urine out with your poo from your rectum.

This operation is also called a Mainz 2 or a uretersigmoidostomy procedure. It is carried out by specialist surgeons.

Who can have a recto sigmoid pouch?

A rectosigmoid pouch isn’t suitable for everyone. You might be able to have this type of surgery if:

  • your cancer is stage T3 or less
  • the muscle in your bottom that controls your bowel movements (anal sphincter) works well
  • your bowels are working well and you don’t have other bowel problems, such as Crohn's disease or previous bowel surgery
  • your kidneys are working well
  • you haven’t had and won’t be having radiotherapy to your pelvic area

What happens

You have this operation while you’re asleep, so you will have a general anaesthetic. This operation can take between 2 and 6 hours.

The surgeon makes the rectum into a pouch. They do this by adding a piece of bowel taken from higher up.

They then attach the tubes that carry urine down from your kidneys (the ureters) to the pouch. The pouch collects the urine. You use the muscle in your bottom (anal sphincter) to hold it in.

Diagram showing a rectosigmoid pouch

After your recto sigmoid pouch

When you wake up from surgery you’ll have a lot of tubes attached to your body. Don’t worry this is to help in your recovery. These tubes will gradually get less as you recover and prepare to go home.

You’ll be in hospital for about 1 to 2 weeks after this operation.

You’ll go home with a tube to drain your urine (catheter) until your new bladder joins heal. When you next see your surgeon they’ll make sure there are no leaks at the joins. If there are no leaks, they take out your catheter.

There is a risk of developing bowel cancer after this type of operation. You’ll have regular check ups with your doctor after this operation. You usually have a yearly procedure called a flexible sigmoidoscopy to check your bowel for signs of cancer.

Passing urine

Your urine will now pass into your new pouch then through your rectum. At first, it will take time for you to gain control of this, so you may have some accidents (be incontinent). You may want to wear pads at first until you gain good control.

You need to go to the toilet very often to start with until you learn to control the muscle in your bottom (anal sphincter).

Your new pouch also needs to learn to stretch so it can hold larger amounts of urine. You’ll eventually be passing urine less frequently during the day and night. There’s no exact time on how long it will take you to gain good control. For some, it may take weeks or even months.  

It’s important that you’re drinking plenty of liquids to prevent kidney infections after this operation. Your bowel naturally makes mucus this can attract bacteria to grow, the bacteria can travel up the ureters to the kidney from the bowel and cause infections.

Last reviewed: 
19 Jun 2019
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    J A Witjes and others
    European Association of Urology, 2017

  • The ethical and technical aspects of urinary diversions in low-resource settings: a commentary
    J Wilkinson and others
    Journal of Obstetrics and Gynaecology, 2016. Pages 1273 - 1277

  • Good Practice in Health Care. Continent Urinary Diversion.
    V Geng and others
    European Association of Urology Nurses, 2010.

  • Revisiting Uretersigmoidostomy, a useful technique of Urinary Diversion in Functional Urology.
    M Przydacz and others
    Urology, 2018. Volume 115, Pages 14 - 20

  • Long-term outcome of ureterosigmoidostomy: an analysis of patients with >10years of follow-up.
    M K Tollefson and others
    BJU International, 2010. Volume 105, Issue 6.

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular risk or cause you are interested in. 

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