The Effect of Restorative Proctocolectomy on Sexual Function, Urinary Function, Fertility, Pregnancy and Delivery: A Systematic Review
- 1 August 2007
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 50 (8), 1128-1138
- https://doi.org/10.1007/s10350-007-0240-7
Abstract
This study was designed to evaluate the effect of restorative proctocolectomy on sexual function, urinary function, fertility, pregnancy, and delivery in patients with ulcerative colitis. A systematic literature search was performed of articles published between 1980 and 2005 on patients undergoing restorative proctocolectomy for ulcerative colitis reporting data on the outcomes of interest. A random-effect, meta-analytical model was used for pooled estimates and 95 percent confidence intervals. A total of 22 studies, with 1,852 females, were included. Infertility rate was 12 percent before restorative proctocolectomy and 26 percent after, among 945 patients in seven studies. The incidence of sexual dysfunction was 8 percent preoperatively and 25 percent postoperatively (7 studies, n = 419). Two studies (n = 62) reported no urinary dysfunction in patients undergoing restorative proctocolectomy. There was an increased incidence of cesarean section after restorative proctocolectomy. During the third trimester of pregnancy, there was an increase in stool frequency by 1.15 stools per day compared with before pregnancy frequency (n = 49 95 percent confidence interval, 0.28-2.03 P = 0.01 chi-squared statistic, 0.04 P = 0.84). No significant differences were seen in pouch function after vaginal delivery (n = 456; weighted mean difference, 0.23; 95 percent confidence interval, 0.43-0.88; P = 0.49; chi-squared statistic, 1.29; P = 0.26). The incidence of dyspareunia increases after restorative proctocolectomy. There was a decrease in fertility after restorative proctocolectomy. Pregnancy after restorative proctocolectomy was not associated with an increase in complications. There was an increase in stool frequency and pad usage during the third trimester. Vaginal delivery is safe after restorative proctocolectomy. Pouch function after delivery returns to pregestational function within six months.Keywords
This publication has 44 references indexed in Scilit:
- A Comparison of Hand-Sewn Versus Stapled Ileal Pouch Anal Anastomosis (IPAA) Following ProctocolectomyAnnals of Surgery, 2006
- Inflammatory bowel disease: the view of the surgeonColorectal Disease, 2006
- Which career first?BMJ, 2005
- Fertility is reduced after restorative proctocolectomy with ileal pouch anal anastomosis: A study of 300 patientsSurgery, 2004
- Functional Outcomes After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative ColitisAnnals of Surgery, 2000
- Fertility and sexual and gynecologic function after heal pouch-anal anastomosisDiseases of the Colon & Rectum, 1994
- Omission of temporary diversion in restorative proctocolectomy — Is it safe?Diseases of the Colon & Rectum, 1993
- The effect of pregnancy and delivery on the ileal pouch-anal anastomosis functionsDiseases of the Colon & Rectum, 1989
- Successful childbirth after restorative proctocolectomy with pelvic ileal reservoirBritish Journal of Surgery, 1984
- Restorative Proctocolectomy with a Three-loop Heal Reservoir for Ulcerative Colitis and Familial Adenomatous PolyposisAnnals of Surgery, 1984