Rectal, bladder and sexual function after mucosal proctectomy with and without a pelvic reservoir for colitis and polyposis

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Abstract
Sexual, bladder and rectal function have been assessed prospectively in a group of patients undergoing mucosal proctectomy, primarily for ulcerative colitis. The function of the rectum and ‘neo‐rectum’ was studied before and 3 months (on average) after operation in 18 patients. Intestinal continuity was restored by means of ileo‐anal anastomosis; in addition to ileo‐anal anastomosis, a pelvic reservoir (MP + RES) was constructed in 10 patients, while ileo‐anal anastomosis alone (MP + IAA) was used in the remaining 8 patients. Thirteen of these patients have been studied for a minimum of 4 months after closure of the defunctioning ileostomy. No evidence of impotence or of bladder dysfunction due to trauma to pelvic autonomic nerves was noted. Evidence of impairment of function of the internal anal sphincter was observed soon after operation in 16 of the 18 patients (P < 0·05). However, reflex function of the external anal sphincter could still be elicited in over 70 per cent of patients who were tested 3 months after operation. The functional results of patients after MP + RES were significantly better than those of patients who had undergone MP + IAA. Thirteen months (on average) after closure of the ileostomy, the maximum capacity and compliance of the ‘neo‐rectum’ in patients after MP + RES (423 ± 87 ml and 14 ± 7 ml/cm H2O respectively) were significantly greater than in patients after MP + IAA (181 ± 103 ml and 4 ± 3 ml/cm H2O respectively; P < 0·05). A significant correlation between the capacity of the ‘neo‐rectum’ and the frequency of defecation was noted. The results of the present study support the suggestion that a pelvic reservoir should be fashioned in adults undergoing mucosal proctectomy and ileo‐anal anastomosis for inflammatory bowel disease.