Female infertility after ileal pouch-anal anastomosis for ulcerative colitis.

PURPOSE: Although ulcerative colitis commonly affects young females, the impact of ulcerative colitis and its treatment on female fertility have not been well studied. The purpose of this survey was to examine the impact of ulcerative colitis and ileal pouch-anal anastomosis on female reproductive ability. METHODS: Demographic, reproductive history, and disease history information were obtained via a questionnaire mailed to females who had pelvic pouch surgery or nonoperative management for ulcerative colitis. Based on age at diagnosis, age at surgery, and marital status, 153 females who had pelvic pouch surgery and 60 females who had nonoperative management for ulcerative colitis were identified for inclusion. Patients were asked if they attempted to become pregnant, when relative to their diagnosis or surgery, and if they were successful. Married or cohabiting females aged 18 to 44 years who failed to become pregnant during 12 months of unprotected intercourse were defined as infertile. RESULTS: The infertility rate was significantly higher in females who had pelvic pouch surgery compared with females managed nonoperatively (59/153 (38.1 percent) vs. 8/60 (13.3 percent), respectively; P < 0.001). There was no difference in female fertility after diagnosis with ulcerative colitis compared with before diagnosis (odds ratio, 0.68; P = 0.23). In contrast, there was a 98 percent reduction in fertility after pelvic pouch surgery compared with before surgery (odds ratio, 0.021; P < 0.0001). By logistic regression, increasing age was the only factor associated with failure to become pregnant after surgery (odds ratio, 1.136 per additional year of age; P = 0.027). CONCLUSIONS: Females with ulcerative colitis who are managed nonoperatively have normal fertility, which suggests that ulcerative colitis and medical therapy do not decrease female reproductive ability. After pelvic pouch surgery for ulcerative colitis, female fertility is significantly decreased and this problem should be discussed routinely with patients considering this procedure.

[Comparison between colonic J-pouch anal anastomosis and straight coloanal anastomosis following low anterior resection of the rectum].

BACKGROUND: Low anterior resection, colo-anal anastomosis with anal sphincters preservation has become the routine procedure for the treatment of low rectal cancer. This method avoids the need for a permanent colostomy without compromising oncological principles. However, many of these patients experience symptoms of fecal frequency, urgency and variable degree of incontinence. Improvement with the functional results has been reported in patients in whom continuity has been restored by means of colonic j pouch. AIM: To compare the outcome of anterior resection and colonic pouch anal anastomosis (CPAA) with the conventional straight coloanal anastomosis (SCAA). MATERIAL & METHODS: The files of patients who underwent anterior resection with CPAA or SCAA between 1994-2001 were analyzed retrospectively. Patients filled out an updated questionnaire regarding their functional outcome. RESULTS: Thirty nine patients underwent CPAA and 42 SCAA. Mean follow-up was 31 months. There was no perioperative mortality and the rate of complications was similar in the two groups. Bowel movements per 24 hours were 4.2 and 6 in the CPAA and the SCCA groups respectively. The bowel movements during night were 0.4 and 1.5 respectively. Sixty percent of patients after CPAA had 3 or less bowel movements per 24 hours as compared to 44% of patients after SCAA. Continence scores were 3.9 and 3.5 in patients after CPAA and SCAA respectively. Seventy two percent of patients after CPAA reported continence scores of 4 or more as compared to only 51% of patients in the SCAA group. CONCLUSION: Our results confirm previous reports that anterior resection and CPAA improves the functional outcome and quality of life after sphincter saving operation for low rectal cancer.

Kidney allografts and remaining contralateral donor kidneys before and after transplantation: assessment by quantitative (99m)Tc-DMSA SPECT.

UNLABELLED: We used (99m)Tc-dimercaptosuccinic acid (DMSA) quantitative SPECT (QDMSA) to assess the function of kidneys before harvesting and after transplantation as well as the function of remaining donor kidneys. METHODS: Nineteen kidney donors underwent a baseline QDMSA study before nephrectomy. The allografts of these kidneys were studied in recipients at 1 wk, 1-2 mo, and 6-15 mo after transplantation. The kidneys remaining in 16 donors were studied at 1-2 mo and 6-15 mo after harvesting. The parameters obtained in each SPECT study included functional volume, concentration of (99m)Tc-DMSA per cubic centimeter of renal tissue, and total kidney uptake. Clinical evaluation and determination of serum creatinine levels took place at the same time as SPECT. RESULTS: On the basis of the clinical evaluation, 14 grafts had normal function and 5 were impaired. The mean +/- SD of kidney uptake values expressed as percentage of baseline values were 131% +/- 30% in normal grafts versus 57% +/- 5% in impaired grafts at 1 wk (P < 0.01), 173% +/- 57% versus 65% +/- 10% at 1-2 mo (P < 0.001), and 190% +/- 50% versus 69% +/- 14% at 6-15 mo after transplantation (P < 0.01). Uptake values in the donors' remaining kidneys were 159% +/- 27% of baseline values at 1-2 mo and 164% +/- 30% at 6-15 mo after nephrectomy. Allografts and remaining kidneys showed a similar increase in total kidney uptake as a result of an increase in both functional volume and concentration. CONCLUSION: QDMSA may be a noninvasive assessment tool in kidney transplantation from living donors.