Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025
Impact of total proctocolectomy with ileal pouch-anal anastomosis on sexual function, psychological well-being and quality of life in ulcerative colitis: A prospective cohort from the GETAID chirurgie group.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Noiret Barbara, Cotte Eddy, Lefevre Jérémie H, Beyer-Berjot Laura, Zerbib Philippe, Brouquet Antoine, Desfourneaux Véronique, Duffas Jean-Pierre, Germain Adeline, Lakkis Zaher, Ouaissi Mehdi, Tuech Jean-Jacques, Brigand Cécile, Trilling Bertrand, Arquilliere Justine, Denost Quentin
Аннотация
BACKGROUND AND AIMS: Total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for patients with ulcerative colitis refractory to medical therapy. While its impact on bowel function is well documented, its effects on sexual function remain controversial. This study aimed to evaluate changes in sexual function, psychological outcomes (anxiety, depression and fatigue) and quality of life (QoL) after surgery.
METHODS: This prospective multicentre cohort study included patients undergoing IPAA. Sexual function was assessed using the IIEF-5 (men) and FSFI (women). Psychological status, fatigue and QoL were evaluated using the HADS, FSS and SIBDQ, respectively. Validated patient-reported outcome measures were collected at baseline and 6-12 months postoperatively.
RESULTS: A total of 332 patients were included. Male sexual function remained stable: 50% reported erectile dysfunction (ED) at baseline with no significant change postoperatively. Female sexual function improved significantly, particularly in desire (p = 0.002) and arousal (p = 0.003). Anxiety and depression (HADS) decreased significantly over time (p < 0.001), as did fatigue (FSS ≥4 dropping from 43% to 25%, p = 0.004). QoL improved markedly, with the proportion of patients reporting poor QoL (SIBDQ <45) reduced threefold at 12 months (p < 0.001). Depressive symptoms were strongly associated with ED in men (OR = 14.46, p = 0.021), while disease extent had no significant effect on sexual function.
CONCLUSIONS: IPAA was associated with significant improvement in psychological well-being, fatigue and QoL, with notable improvements in sexual function among women. However, persistent sexual dysfunction-particularly in women and in men with depressive symptoms-underscores the need for tailored psychological support in the perioperative period.
METHODS: This prospective multicentre cohort study included patients undergoing IPAA. Sexual function was assessed using the IIEF-5 (men) and FSFI (women). Psychological status, fatigue and QoL were evaluated using the HADS, FSS and SIBDQ, respectively. Validated patient-reported outcome measures were collected at baseline and 6-12 months postoperatively.
RESULTS: A total of 332 patients were included. Male sexual function remained stable: 50% reported erectile dysfunction (ED) at baseline with no significant change postoperatively. Female sexual function improved significantly, particularly in desire (p = 0.002) and arousal (p = 0.003). Anxiety and depression (HADS) decreased significantly over time (p < 0.001), as did fatigue (FSS ≥4 dropping from 43% to 25%, p = 0.004). QoL improved markedly, with the proportion of patients reporting poor QoL (SIBDQ <45) reduced threefold at 12 months (p < 0.001). Depressive symptoms were strongly associated with ED in men (OR = 14.46, p = 0.021), while disease extent had no significant effect on sexual function.
CONCLUSIONS: IPAA was associated with significant improvement in psychological well-being, fatigue and QoL, with notable improvements in sexual function among women. However, persistent sexual dysfunction-particularly in women and in men with depressive symptoms-underscores the need for tailored psychological support in the perioperative period.
Предметные рубрики MeSH
HumansProctocolectomy, RestorativeFemaleQuality of LifeColitis, UlcerativeMaleProspective StudiesAdultMiddle AgedColonic PouchesPatient Reported Outcome MeasuresDepressionAnxietySexual Dysfunction, PhysiologicalTreatment OutcomeFatiguePostoperative ComplicationsErectile DysfunctionPsychological Well-Being