Improvement in Functional Outcomes Following Ileal Pouch-Anal Anastomosis: Results from the United States Ileal Pouch-Anal Anastomosis (TULIP) Study

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Diseases of the Colon and Rectum

Abstract

Purpose/Background: Ileal pouch-anal anastomosis (IPAA) is the standard operative approach in patients with ulcerative colitis (UC) and unclassified inflammatory bowel disease (IBD-U) desiring restoration of intestinal continuity. Studies describing functional outcomes are retrospective, limited to single-center experience, lack baseline comparison, and fail to report on all patient-important domains such as bowel, urinary, and sexual function. We sought to produce robust prospective data on functional outcomes in patients undergoing IPAA across multiple centers.

Methods/Interventions: Patients with UC or IBD-U undergoing IPAA between 06/2018 and 06/2022 across North American centers were enrolled prospectively. We used validated questionnaires to evaluate patient-reported outcomes of overall (PROMIS Global-10), colorectal (COREFO, Wexner Fecal Incontinence), sexual (PROMIS Sex-FS), and urinary (International Prostate Symptom Score) function. Preoperative demographics and baseline function were obtained before colectomy. Operative data, postoperative surgical outcomes, and functional measures at 3, 6, and 12 months after ileostomy closure were evaluated. We analyzed mean functional score trajectories over time using line graphs and longitudinal mixed models.

Results/Outcomes: There were 203 patients included in the study; mean age was 35.8±13.4 and 59% were male. Most patients had UC (95%) with refractory disease the most common indication for surgery (91%). Fifty-seven patients (28%) had a subtotal colectomy without eventual IPAA. The rest had either 2-stage (n=21; 14%) or 3-stage (n=125; 86%) IPAA. Of those, nine patients (6%) did not have their ileostomy closed at one year post-IPAA. Global health satisfaction increased after IPAA in domains of both mental (mean Tscore 41.5±10.8 at baseline to 51.2±10.3 at 12 months, p< 0.0001) and physical health (mean T-score 39.2±9.2 at baseline to 52.2±9.2 at 12 months, p< 0.0001). Overall bowel function improved (COREFO mean 50.6±18.8 at baseline to 24.3±17.7 at 12 months, p< 0.0001; Wexner mean 8.2±5.3 at baseline to 4.3±4.5 at 12 months, p< 0.0001), as did underlying domains of frequency, social impact, stool-related aspects, and incontinence. Medication need did not change over time. Urinary function was stable (mean score 6.6±6.3 at baseline to 5.4±6.3 at 12 months, p=0.23). Sexual interest increased postoperatively for both females (mean T-score 34.2±13.2 at baseline to 41.9±13.0 at 12 months, p=0.007) and males (mean T-score 39.4±13.8 at baseline to 51.1±9.6 at 12 months, p< 0.0001). Other domains of female sexual function, including global satisfaction, lubrication, orgasm satisfaction, orgasm ability, and vaginal discomfort remained similar to baseline over time. Male global satisfaction and orgasm ability was increased, whereas erectile function and orgasm satisfaction was similar to baseline.

Conclusion/Discussion: In this first multicenter prospective study of functional outcomes after IPAA, we observed significant improvements in physical and mental health, colorectal function, and sexual interest in patients who underwent IPAA for UC or IBD-U. Importantly, there were no negative changes in urinary dysfunction and several domains of female and male sexual function such as lubrication, vaginal discomfort, erectile function, and orgasm, suggesting that postoperative urinary and sexual dysfunction is likely rare. These results are important to help guide preoperative counselling and decision-making for patients considering restorative IPAA.

Volume

68

Issue

5

First Page

e808

Comments

American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting, May 10-13, 2025, San Diego, CA

Last Page

e809

DOI

10.1097/DCR.0000000000003735

ISSN

1530-0358

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