Quality of life, sexual function and fertility in patients with ulcerative colitis before and after continence preserving surgery

Abstract

Surgery is required when the medical management of ulcerative proctocolitis fails to control the disease. The curative surgical options - the continent ileostomy (CI) and the ileal pouch-anal anastomosis (IPAA) - omitting the need for a conventional ileostomy have been introduced in recent years aiming to improve quality of life (QL). The long-term results on QL are poorly documented after theas operations.Aim: To evaluate these surgical options in terms of quality of life with additional interest focussed on sexual function and fertility.Patients and methods: Patients were interviewed before and after IPAA. General (GQL) was assessed according. to Kajandi, and disease specific (DQL) according to a modified ostomy adjustment scale . The impact of the operation on sexuality was assessed. Women were interviewed on pregnancy and a gynecological examination and hysterosalpingography (HSG) was done. The fecundability in IPAA females and a control population was compared.The long-term morbidity in CI patients was assessed and their health related quality of life (HQL) (SF- 36) was compared with a norm population.Results: While the DQL improved (p<0,001) the GQL did not change after IPAA. The role function, the body image and the relief of the adverse effects of the disease and the ileostomy were the main benefits. The majority of patients had regained sexual activity soon after surgery with an unchanged frequency of intercourse. The IPAA seemed to have no significant adverse effects on male or female sexuality. While the gynecological examination was normal, HSG demonstrated abnormalities in two thirds of the patients. Females with IPAA had few pregnancies. The fecundability ratio was significantly reduced as compared to controls (P>0.001). The long term follow up of the CI patients showed a high frequency of functional problems but reoperations for restoration of continence resulted in higher saelvage rate. The HQL was similar to that in the controls.Conclusion: The IPAA operation improved DQL but had no significant influence on the GQL. Sexual activity remained unchanged. A high incidence of abnormalities in the fallopian tubes could be demonstrated and the fecundability proved to be reduced. CI patients had a HQL similar to that in a norm population