- Sexual dysfunction and impairment of quality of life due to fecal incontinece were common after classical operations for anorectal malformations. We hypothesised that modern repairs may have improved outcomes.
A single-institution, cross-sectional study. After ethical approval, all patients ≥16 years of age treated for rectourethral-, vestibular- and perineal fistula from 1983 were went detailed postal questionnaires on sexual function and quality of life. Respondents were age- and gender- matched to 3 controls each randomly selected from the general population. Penoscrotal/gynecologic abnormalities were obtained from records.
41 patients (62%; median 22 years) participated: 20 males with rectourethral fistula (60% prostatic), 10 females with vestibular/perineal fistula, and 11 males with low malformations. Although experience of sexual relationships and orgasmic function were reported in comparable proportions to controls, age at coital debut was significantly delayed in all groups of patients (p≤0.046). Erectile function was preserved after sagittal repair, but absent ejaculations or azoospermia affected 3 males with rectourethral fistula (15%). Penoscrotal/gynecologic abnormalities affected 12%. Overall quality of life scores were comparable to controls, but tendency for lower scores in emotional items in males with rectourethral fistula (p=0.06), and negative effect on sexual life in females (p=0.03) was found.
Whilst erectile and orgasmic function appeared preserved after sagittal repair, further evaluation of fertility issues in males with rectourethral fistula is indicated. Larger multicenter studies are needed to confirm findings.
The Journal of urology. 2016 Aug 17 [Epub ahead of print]
Kristiina Kyrklund, Seppo Taskinen, Risto J Rintala, Mikko P Pakarinen
Department of Pediatric Surgery University of Helsinki, Hospital for Children and Adolescents Helsinki, Finland. Electronic address: ., Department of Pediatric Surgery University of Helsinki, Hospital for Children and Adolescents Helsinki, Finland.