PM1062: Long-term Male Sexual Function and Continence Outcomes After Pediatric Pelvic Surgery for Hirschsprung’s Disease or Anorectal Malformation

Background: Anorectal malformations (ARM) and Hirschsprung’s disease (HD) are rare congenital colorectal malformations requiring pelvic floor surgical interventions in early childhood. Studies evaluating long-term sexual function and continence outcomes into adulthood are very limited. In healthy males aged 18-31 in the United States, 11.3% and 2.9% report mild and moderate to severe erectile dysfunction (ED) respectively.1 In ARM or HD patients, the rates of reported ED and ejaculatory dysfunction (EjD) range from 5-12%, and 15-40%, respectively. Similarly, while it is clear children with ARM and HD may struggle with incontinence post-operatively, there is little data evaluating fecal incontinence related quality of life into adulthood. The goal of this study was to characterize both sexual function and continence quality of life outcomes for adult male patients treated for ARM or HD.

Methods: We conducted a prospective survey study to evaluate sexual function and continence quality of life outcomes in patients 18 years or older with ARM or HD treated surgically. Patients were identified from our institutional database. They were then contacted by telephone and informed about the study. A REDCap survey was sent via email. The International Index of Erectile Function (IIEF-5) and Male Sexual Health Questionnaire (MSQH) were employed to evaluate ED and EjD respectively. To assess continence, we utilized the Cleveland Clinic Incontinence Score (CCIS) and the Fecal Incontinence Quality of Life Scale (FIQL). To evaluate for any association between sexual function and incontinence, a linear regression analysis of IIEF-5 scores compared to CCIS scores was performed.

Results: We attempted to contact 217 patients, 55 had invalid contact information and 99 were unable to be reached after three attempts. We reached 63 patients, 8 declined to participate, 7 initially agreed to participate but failed to complete the survey, and 48 completed the survey. The median age for respondents was 22.5 years (IQR 20.1-25, range 18-48). There were 19 cases of HD and 29 cases of ARM. On the IIEF-5 survey, 25.9% reported mild ED, 11.1% reported mild-moderate ED, with one case of severe ED (Table 1). On the MSHQ-EjD survey there was minimal reported EjD with a median score of 14 (IQR 10.75 – 15) out of 15 with lower scores indicating greater dysfunction. The median CCIS was 5 (IQR 2.25-7.75) and the median FIQL scores ranged from 2.7 – 3.5 out of 5 depending on the domain assessed, demonstrating some expected quality of life challenges secondary to concerns with fecal incontinence (Table 2). Furthermore, IIEF-5 scores were associated with CCIS scores (B = -0.55, p = 0.0447).

Conclusion: Male adult patients treated for ARM or HD likely have ongoing concerns with sexual function and fecal incontinence related quality of life outcomes, with associations between greater fecal incontinence concerns and ED.