What is the benefit of preoperative sperm preservation for patients who undergo restorative proctocolectomy for benign diseases?

PURPOSE: In patients with benign colorectal diseases undergoing a restorati ve proctocolectomy with an ileal pouch-anal anastomosis, semen cryopreserva tion seems rational to enable the possibility of procreation in case surger y leads to sexual disorders or impotence. The aim of this study was to dete rmine the preoperative and postoperative semen quality in patients undergoi ng ileal pouch-anal anastomosis. In addition, the study sought to determine the incidence of surgery-induced sexual dysfunction to evaluate the econom ic efficiency of semen cryopreservation as compared with alternatives such as microsurgical epididymal sperm aspiration. METHODS: Preoperative and pos toperative semen analyses were offered to 97 patients with ileal pouch-anal anastomosis with benign colorectal diseases since 1989. The direct costs o f the semen cryopreservation program were determined and compared with thos e of alternatives. RESULTS: In 34 of 40 consecutive patients with ileal pou ch-anal anastomosis who made use of preoperative semen preservation, normal sperm concentrations, motility, and morphology were found. Mean semen char acteristics of all 23 patients who returned for postoperative analysis were not different from preoperative values, but they were for total sperm numb er. Two patients developed temporary retrograde ejaculation postoperatively . None of the preserved semen samples was used, thus semen cryopreservation benefited none of these patients. The total costs of semen cryopreservatio n are between 2.2 and 5 times higher than the costs for one microsurgical e pididymal sperm aspiration procedure. CONCLUSIONS: Preoperative semen cryop reservation in patients undergoing ileal pouch-anal anastomosis because of benign colorectal diseases is quite feasible. However, most likely because of improved surgical techniques and the increasing number of effective alte rnatives, preoperative semen cryopreservation in patients with ileal pouch- anal anastomosis is no longer cost effective.