A Prospective Evaluation of Sexual Function and Quality of Life After Ileal Pouch-Anal Anastomosis

Davies, R. Justin; O’Connor, Brenda I.; Victor, Charles; MacRae, Helen; Cohen, Zane; McLeod, Robin S.

doi:10.1007/s10350-008-9248-x

Cited by 78 publications

(68 citation statements)

References 14 publications

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“…Samkvaemt niðurstöðum hafði aðgerð ekki marktaek áhrif á kynlíf karlmanna en baetti kynlíf kvenna svo um munaði. 22 Niðurstöður japanskrar rannsóknar bendir hins vegar til þess að aðgerðir sem þessi geti haft töluverð neikvaeð áhrif á kynlíf sjúklinga eftir aðgerð. Nítján af 60 sjúkling-um (31%) lýstu neikvaeðum áhrifum á kynlíf, 24% karlmanna og 38% kvenna.…”

Section: R a N N S ó K Nunclassified

Lífsgæði eftir ristilbrottnám vegna sáraristilbólgu

Gudlaugsdottir¹,

Valsdóttir²,

Stefánsson³

2016

LBL

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4Brottnám á ristli og endaþarmi er mikilvaegur þáttur í með-ferð á sáraristilbólgu. Ábendingar fyrir bráðaaðgerð eru oftast bráð ristil bólga sem ekki raeðst við með lyfjum og sjaldnar rof á ristli eða blaeðingar. Ábendingar fyrir valaðgerðum eru skortur á svörun við lyfjameðferð, krabbamein eða krabbameinsáhaetta, þrenging á görn, fylgisjúkdómar utan garnarinnar og þegar börn þrífast ekki. 5,6 Líkur á þörf fyrir ristilbrottnám eru 31% laegri meðal þeirra sem hafa verið meðhöndlaðir með infliximab en með cyclosporíni. Hlutfall sjúklinga sem fer í ristilbrottnám er haerra í fyrsta "kasti" en síðari "köstum" (17,2% á móti 10,6%). Alvarleiki ristilbólgu og aldur eru mikilvaegir forspárþaettir fyrir ristilbrottnám. 7Hlutfall sjúklinga með sáraristilbólgu sem þarf á aðgerð að halda einu, 5 og 10 árum eftir greiningu var 4,9%, 11,6% og 15,6% árin 1955-70 og hefur farið laekkandi síðustu 6 áratugi. Meðal sjúk-linga sem greindust árin 2000-2010 var hlutfallið eftir eitt og 5 ár Tilgangur: Þónokkur hluti sjúklinga með sáraristilbólgu fer í ristilbrottnám. Markmið rannsóknarinnar var að kanna lífsgaeði þessara sjúklinga eftir aðgerð. Efniviður og aðferðir: Allir sjúklingar með sáraristilbólgu sem fóru í ristilbrottnám á Landspítala eða Sjúkrahúsi Akureyrar á árunum 1995-2009 og voru á lífi í upphafi rannsóknar voru í úrtakinu. 106 sjúklingar fengu senda þrjá spurningalista. SF-36v2 og EORCT QLQ-CR29 eru staðlaðir lífsgaeða listar þar sem spurt er um almennt viðhorf til heilsu og um einkenni frá endaþarmi eða stóma. Þriðji listinn innihélt starfraenar spurningar hannaðar af rannsóknaraðilum. Niðurstöður: Svör bárust frá 83 (78%), 45 körlum (54%) og 38 konum (46%). Meðalaldur við aðgerð var 45 ár (10-91 ár). Fjörutíu og fjórir (53%) höfðu garnarauf, 28 (34%) innri garnapoka (IPAA) og 11 (13%) tengingu mjógirnis í endaþarm. Hjá sjúklingum þar sem endaþarmur var fjarlaegður lýstu 37% breytingum á þvaglátum og 46% á kynlífi eftir aðgerð. 75% svarenda með innri garnapoka lýstu haegðaleka en hann var vaegur samkvaemt Wexner-skala hjá 83% þeirra. Enginn munur var á lífsgaeðum þátttakenda og almenns þýðis samkvaemt SF-36v2. Sjúklingar höfðu litlar áhyggjur af heilsu, líkamsímynd eða þyngd og höfðu aðeins mild einkenni samkvaemt EORTC QLQ-CR29. Ályktanir: Algengt var að breytingar yrðu á þvaglátum og kynlífi eftir aðgerð þegar endaþarmur var fjarlaegður. Haegðaleki hjá þeim sem fengu innri garnapoka virtist mun algengari en búist var við. Ekki var marktaekur munur á lífsgaeðum þeirra sem höfðu farið í aðgerð og almenns þýðis. Niðurstöður rannsóknarinnar eru mikilvaegar þegar verið er að upplýsa sjúklinga um aðgerðarmöguleika þar sem brottnám á ristli eða það að hafa stóma virðist ekki skerða lífsgaeði. Á G R I P2,3% og 7,6%.8 Aðalaðgerðin vegna sáraristilbólgu er brottnám á ristli og endaþarmi með endagarnarauf. Stómapokinn getur verið óþaegilegur og hindrað þá sem þurfa að hafa hann. Breytingar á meðferðinni hafa því miðast við það að losa sjúklinga við stóma-pokann. Ef endaþarmurinn er ekki sjúkur er haegt að skilja hann eftir og...

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Section: R a N N S ó K Nunclassified

Lífsgæði eftir ristilbrottnám vegna sáraristilbólgu

Gudlaugsdottir¹,

Valsdóttir²,

Stefánsson³

2016

LBL

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“…RP-IPAA has been found to be associated with erectile dysfunction and retrograde ejaculation in 2-3% of male patients [60]. Conversely, a considerable rate (22-40%) of dyspareunia or sexual dysfunction has been observed in women with a relevant decline in fertility [60].…”

Section: Surgerymentioning

confidence: 99%

“…Conversely, a considerable rate (22-40%) of dyspareunia or sexual dysfunction has been observed in women with a relevant decline in fertility [60]. Some authors have suggested that intraperitoneal adhesion can be the cause of tubular blockage-related infertility [60]. The laparoscopic approach might reduce the chance of postoperative peritoneal adhesions [61].…”

Section: Surgerymentioning

confidence: 99%

Refractory Distal Ulcerative Colitis: Is Proctocolectomy Always Necessary?

Carvello¹,

Montorsi²,

Spinelli³

2014

Dig Dis

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Refractory distal ulcerative colitis (RDUC) is defined as persistence of symptoms caused by endoscopically proven colonic inflammation located at the rectum or left colon despite oral/topical steroids and 5-ASA. RDUC affects a small subset of patients and is associated with chronic disabling symptoms and increased social/medical costs. Moreover, patients with long-standing ulcerative colitis (UC) carry an elevated risk of developing colorectal cancer and colonic mucosa high-grade dysplasia. Alternative medical strategies in steroid refractory disease are unlikely to provide durable remission in all patients, carry potential severe side effects and, as immunosuppressants, the risk of other neoplasms, and may increase the short-term complication rate when surgery is finally required. Restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) allows the complete removal of the diseased rectum and colon, virtually eliminating the risk of malignant transformation and reestablishing intestinal continuity with continence preservation. Since the introduction of this surgical procedure, morbidity and mortality rates have been drastically reduced. Despite the still notable rate of surgical complications, long-term quality of life assessment has shown excellent results in nearly all patients who have undergone RP-IPAA, comparing well with the general population. Furthermore, when performed for distal UC, RP-IPAA produces similar surgical outcomes with respect to pancolitis. In conclusion, RP-IPAA should always be considered in patients with RDUC, and multidisciplinary counseling should provide patients clear information about the advantages of surgery and possible complications as well as the chance to achieve disease remission with medical therapy.

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“…26 Both instruments have been used in previous studies on patients with IPAA. 13,14,19,20 Hormonal replacement therapy (HRT) for women and injection or oral therapy for erectile dysfunction for men were also recorded. 27,28 Body image was assessed using a 10-item scale, the Body Image Scale (BIS), consisting of affective items (e.g.…”

Section: Sexual Functionmentioning

confidence: 99%

“…impotence, impaired lubrication, pain during intercourse and desire, vary. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] This aspect of quality of life is poorly considered in standard instruments. Reported improvement of sexual function may be an effect of excision of the source of chronic inflammation and a better general health status.…”

Section: Introductionmentioning

confidence: 99%

Sexual function after failed ileal pouch-anal anastomosis

Bengtsson¹,

Lindholm²,

Nordgren³

et al. 2011

Journal of Crohn's and Colitis

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Background and Aims: Failure of ileal pouch-anal anastomosis (IPAA) occurs in around 10% of the patients. Compared to patients with functioning pouches, health related quality of life is deteriorated after failure. Sexual function in patients with pouch failure is however poorly studied. The aim was to study sexual function in patients with pelvic pouch failure; patients with functioning pouches were used as controls. The hypothesis was that patients with pouch failure have worse sexual function. Methods: 36 patients with pouch failure were compared with 72 age and sex-matched controls with ulcerative colitis and functioning pouches. The patients answered a set of questionnaires concerning sexual function (Female Sexual Function Index [FSFI] and International Index of Erectile Function [IIEF]), body image (BIS-scale) and health-related quality of life (SF-36). Results: Both women and men with pouch failure scored lower than controls in the FSFI and IIEF questionnaires. However, none of the observations were statistically significant. The scores in the failure group (for both sexes) were below the cut-off level for sexual dysfunction. Scores for the BIS instrument were significantly lower for both sexes in the failure group. Women and men in the failure group scored lower than the controls in all domains of the SF-36, however statistically significant only for the social function domain in men. Conclusions: The hypothesis, that a failed IPAA is associated with worse sexual function, was not confirmed. Compared to patients with functioning pouches, patients with pouch failure have inferior body image.

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A Prospective Evaluation of Sexual Function and Quality of Life After Ileal Pouch-Anal Anastomosis

Abstract: In men, ileal pouch-anal anastomosis does not have an adverse effect on sexual function, whereas sexual function in women seems to improve 12 months after surgery.

Cited by 78 publications

References 14 publications

Lífsgæði eftir ristilbrottnám vegna sáraristilbólgu

Lífsgæði eftir ristilbrottnám vegna sáraristilbólgu

Refractory Distal Ulcerative Colitis: Is Proctocolectomy Always Necessary?

Sexual function after failed ileal pouch-anal anastomosis

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