Abstracts
1999 Digestive Disease Week

# 2090 WHAT IS THE BENEFIT OF PRE OPERATIVE SPERM PRESERVATION FOR PATIENTS, WHO WILL UNDERGO RECTAL EXCISION FOR BENIGN DISEASES?
Peter van Duijvendijk, Laura T. van Lochem, Frederik M. Slors, Carlo W. Taat, Jan W.A. de Vries, Huug Obertop, Acad Med Ctr, Amsterdam Netherlands

In patients with benign colorectal diseases who have to undergo a restorative proctocolectomy (RPC) and ileal-pouch anal anastomosis (IPAA), semen cryopreservation (SC) offers the possibility of preserving fertility in case surgery would lead to sexual disorders or impotence. The aim of this study was to determine the pre- and post-operative semen quality in patients who had to undergo a RPC, the incidence of post-operative sexual dysfunction and to identify whether the cost-effectiveness of semen banking as compared to alternatives like microsurgical epididymal sperm aspiration (MESA).
Results. In 34 out of 40 male patients (22-43 years) where pre-operative SC has been offered since 1989, sperm concentrations (82±58 106 spermatozoa (sp)/ml), sperm motility(48±16% progression) and morphology (47±20% normal morphology) were normal. Six patients had oligozoospermia (5±4 106sp/ml) preoperatively, although there was no clear relationship with side-effects of anti-inflammatory medication. Sperm concentration (80±101 106sp/ml) and sperm motility (46±15% progression) of 23 patients who returned for postoperative semen analysis was not different from preoperative values, but for total sperm count (232± 226 vs 160± 151 106sp/ml, respectively). Two patients developed retrograde ejaculation postoperatively. None developed permanent impotency. The total SC costs for these 40 patients benefited none, and is between 2.2 and 5 times more expensive than the costs for a MESA procedure in one single patient.
Conclusion SC is feasible preoperatively in patients with benign colorectal diseases. However, in view of the declining complication rates due to improved techniques of RPC with IPAA, and the growing number of more cost-effective alternatives, preoperative semen banking should not be used in these patients.

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