Sexual function and lower urinary tract symptoms after minimally invasive endorectal pull-through in adolescent males with Hirschsprung disease

• Published in: Journal of pediatric surgery 2023-03, Vol.58 (3), p.490-495
• Main Authors: Hoel, Anders Telle, Karlsen, Remi Andre, Fosby, Marianne Valeberg, Bjørnland, Kristin
• Format: Article
• Language: English
• Subjects: Adolescence; Adolescent; Cross-Sectional Studies; Endorectal pull-through; Hirschsprung disease; Hirschsprung Disease - surgery; Humans; Lower urinary tract symptoms; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - surgery; Male; Minimally invasive surgery; Sexual function; Urinary Incontinence; Urination
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.09.017

•Knowledge about sexual function and the presence of lower urinary tract symptoms in Hirschsprung patients is very limited.•Such knowledge is very scarce after specifically minimally invasive endorectal pull-through.•Few studies have explored Hirschsprung males’ ability to ejaculate, and none has reported adolescents’ ability to ejaculate.•Minimally invasive endorectal pull-through seems to preserve erection and ejaculation in adolescent males.•Lower urinary tract symptoms are rare after minimally invasive endorectal pull-through in adolescent males. Effects of colorectal resection on sexual function and the lower urinary tract are inadequately studied in patients with Hirschsprung disease (HD). This study aimed to increase existing knowledge on sexual function and lower urinary tract symptoms (LUTS) in HD male adolescents operated with minimally invasive endorectal pull-through (ERPT). Non-syndromic male adolescents (12–18 years) operated with ERPT were invited to participate in this single-center cross-sectional study which included a semi-structured interview on sexual function and LUTS, a questionnaire recording LUTS, and a urodynamic study. Uroflowmetry curves were eligible for evaluation if the voided volume was >50% of expected bladder capacity. Ethical approval and informed consent were obtained. Of 37 eligible male adolescents, 35 (95%) with a median age of 14.9 (12.0 -18.3) years were included. 94% had rectosigmoid aganglionosis, and 97% underwent a minimally invasive ERPT. 34 (97%) visited the outpatient clinic. The ability to get erections and to ejaculate was assessed in 25/35 (71%) adolescents. 25/25 (100%) could get an erection, and of adolescents ≥15 years 14/15 (93%) could ejaculate. 32 (91%) returned the questionnaire and underwent urodynamic studies. 15/32 (47%) reported LUTS, but most had only sporadic LUTS. 31/32 (97%) were highly satisfied with their bladder function. Sporadic urinary incontinence was reported by 4/32 (13%), but none reported social problems due to this. Of the eligible 28/32 (88%) uroflowmetry curves, 15/28 (54%) were normal. Minimally invasive ERPT seems to preserve sexual function and does not induce lower urinary tract symptoms in adolescent HD males. III.