Introduction

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Urogenital involvement is not rare in patients with inflammatory bowel disease (IBD), but its real incidence has not been defined yet, as demonstrated by the wide range (4-27%) of percentages reported in literature [1-6]. In 1943, Hyams et al. [7] described a ureteral obstruction secondary to chronic enteritis. According to them, that was the first case of urinary disorder of the earliest 1 000 patients suffering from Crohn's disease (CD). In contrast, 40 years later, Kyle stated that as many as 27% of patients with CD will experience urinary disturbances during their life [2]. This apparent discrepancy simply reflects the fact that urinary diseases in IBD patients were (and still are!) often missed or misunderstood. This happens mainly because symptoms are frequently absent or modest and easily obscured by the more severe intestinal problems. However, since minor urinary involvement can result in serious illness (i.e. chronic renal failure), it is important for surgeons and physicians who deal with IBD patients, to be aware of these frequent complications in order to know how to prevent them, to be able to identify high-risk patients, and to chose the most appropriate treatment when these problems occur.

People with inflammatory bowel disease can also experience sexual difficulties. The exact incidence of this phenomenon is not known, as patients may feel embarrassed in discussing it with the doctor. However, it seems to be a common finding which is directly related to the duration and extent of the disease [8]. This is obviously an important problem, especially considering that IBD often affect young adults for a long period of their life.

In 1992, a prospective case-control study among 50 women with CD which had been not surgically treated, showed that although 45 of them had a stable relationship, 24% had no intercourse, compared to 4% of the control group, and the reason for this was mainly the frequent presence of abdominal pain and diarrhoea or the fear of faecal incontinence [9].

As shown in Table 1, some of the urologic and sex-

Table 1. Classification of urinary and sexual manifestations and complications

Urinary involvement

Related to the disease

• Indirectly related (secondary to metabolic derangements): Urinary tract calculi Cystitis Amyloidosis

Nephritis (glomerulonephritis, interstitial nephritis)

• Directly related (secondary to the inflammatory process):

Perirenal or perivesical abscesses Entero-urinary fistulas Ureteral obstruction

Related to medical treatment

• Nephrotoxicity from medical treatment

Related to surgical treatment Urinary tract calculi Urinary retention Ureteral injury

Sexual involvement

Related to the disease

Psychological aspects Loss of libido Generalised debility Presence of cutaneous/perianal disease Dyspareunia secondary to pelvic/perinea! inflammation

Related to medical treatment Loss of libido Impotence Infertility

Vaginal dryness and atrophy

Related to surgical treatment

Neurological damage (impotence, retrograde ejaculation) Vaginal dislocation (dyspareunia) Presence of stoma ual manifestations are the consequence of the metabolic derangement associated with IBD, while others result from a direct involvement of the urinary tract due to the intestinal inflammatory process. In addition, some of them can be caused or favoured by medical or surgical treatment.

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