The effect of restorative proctocolectomy on sexual function, urinary function, fertility, pregnancy and delivery: A systematic review

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.