Jpouch removal in men

You had to be told of this risk when you originally had the colectomy. My understanding is that the risk of impotence is greatest with the colectomy. They should have had you bank your sperm or given you the option at that time. So it is not like you did not assume this risk previously unless you had an emergency colectomy. They did go over this risk with me and not only that, but I had to sign off on an informed consent which stated I understood this risk. No way they were cutting me until I signed off on that.

The stats were 10% risk of temporary impotence and 2% risk of permanent impotence. I think these numbers are still more or less accurate as to the risks from step 1 colectomy. I rolled the dice and did not have a problem, except for the usual age related issues with ED which you will likely experience when you get to your mid 40s or so regardless of surgery.

I would think risk is MUCH lower with J Pouch removal but don't know for sure. It is a procedure that is much smaller in scope than the colectomy which involves vast amounts of cutting in areas where the nerves are microscopic and there is no way for the surgeon to do the job with a 100% guarantee of no disruption in sexual function.

I think the risk might indeed be higher with J-pouch removal than colectomy, though I don't have statistics. The pouch tends to become attached to surrounding structures, so the surgeon has to figure out where the separation should be made, and occasionally they're off a bit.

Nevertheless, if it really has to come out, then the job is to shift the odds in your favor. Do you know why it has to come out (and do you agree)? It makes sense to bank the sperm, just in case. It also makes sense to choose a surgeon who is very experienced with pouch removal. I would ask the surgeon directly how many pouch removals he has done (overall and in the past year). You might need to travel to find an experienced surgeon. Surgery far from home is miserable for a while, but a bad surgical outcome is miserable far longer.

As a rule the risk for impotence is greater with J pouch removal. In the original surgery, a procto-colectomy there is usually no scar tissue so the nerves can be easily seen and avoided. However when the pouch is removed there now is scar tissue and so it can be more difficult to avoid nerve damage. This is one reason why you want a very experienced surgeon to do a J pouch excision. There is also some small chance of urinary incontinence.

Banking sperm if you have even the slightest thought of having children is a really good idea. Retrograde ejaculation is something I had after my first surgery and is pretty common. It mostly resolved on its own after a year or so, not a big deal as I have all the children I intend to have(3).

These issues and some others are why I go ballistic when people say you can always try the J and go back to an ileo. True but there is a price to pay even when things go well as did my pouch excision, it still a big surgery and these surgeries take a toll. All that said I am happy I got it removed.

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In the original surgery, a procto-colectomy there is usually no scar tissue so the nerves can be easily seen and avoided.

This is not what I was told by my surgeon. While your point about scar tissue may be correct, the nerves are not "easily seen and avoided", even when there isn't any scar tissue on the first cut. My surgeon directly told me the exact opposite- that the nerves are not easily detected and avoided and are in fact microscopic. He told me that with a colectomy, there is a 2% chance of permanent impotence and a 10% chance of temporary impotence. At the time he had done thousands of colectomies and was considered the best J Pouch surgeon in the USA and he also did the first K Pouch surgery in the USA. He urged me to bank my sperm, but I never did and I never had any problems with sexual function after surgery, until 15 years later when I had normal age related ED issues.

Ok perhaps I should have said, "the nerves are generally more easily seen" regarding the original surgery as opposed to the excision surgery. The scar tissue issue is real and makes the excision more difficult in many ways. It varies from person to person. The risk of impotence is in the 20% or so range with J pouch excision according to my surgeon. So the general point about first/procto-colectomy surgery being more risky regarding impotence is wrong, which was the point I was trying to make.

I asked my surgeon about this as well. I had my j-pouch removed on the 29th. The greatest risk is during an initial surgery to remove the colon and create the j-pouch. The risk during j-pouch removal is much less. I've been ok during the past 2 1/2 weeks, of course it does depend on your surgeon's skill and experience.

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The greatest risk is during an initial surgery to remove the colon and create the j-pouch.

This is what makes sense to me as well based on what my surgeon told me he had to cut during the initial surgery. There is a tremendous amount of cutting and a tremendous amount of swelling. Huge amounts of tissue are being removed from your body. Huge amounts of tissue are being cut and stitched and are swollen in an area where the nerves controlling sexual function are tiny. The stats I got from my surgeon I researched independently and everything he told me was correct and those stats have remained more or less constant over the course of time.

Just in case any young males are reading this thread and are getting alarmed at the thought of surgery, after my initial colectomy/J Pouch surgery I had an ileus, severe swelling, an infection which raised my white blood cell count off the charts, had the NG tube inserted to stop many hours of vomiting, ran fevers, and recovered from all that to enjoy probably the best 14 years of my life sexually from ages 29 to 43 with a J Pouch. At age 43 I had my first episode of ED but since then can easily overcome ED with cialis. ED is not an all or nothing phenomenon and as you get older it just sort of happens in the middle of things, like a car suddenly breaking down on the highway, then starting up again. That is how my doctor described it (compared erect penis to a car engine depending on a lot of parts all working properly and in unison) and it is a damn good analogy.

Before I had j pouch surgery,I remember my surgeon commenting that because of my narrower hips and pelvis there would be less room to work, and that part of the surgery would be more challenging. It makes sense when you think about it,our rectum/j pouch,bladder, and prostrate are all in the bottom of a funnel shaped pelvis,and as Scott F mentioned,if the anatomy has adhered together,then even all the more delicate.