This topic is about a 32-year-old man who has been dealing with slow-transit constipation since he was 15. This condition led to a colectomy and the creation of an end ileostomy. However, keeping the rectal stump has caused him daily pain, spasms, pressure, and mucus issues for two years. He is now scheduled for surgery to remove the rectal stump completely, known as abdominoperineal excision. His surgeon mentioned a 5% risk of pelvic nerve damage, which could result in erectile dysfunction or loss of fertility. He is seeking advice and experiences from others who have had the same surgery.

Here are some insights and advice shared by others:

1. Personal outcomes:
- Many men who have undergone rectal stump removal report no issues with erectile function or fertility.
- One person experienced serious nerve damage but was not warned about it beforehand.
- Another person, three weeks after surgery, reported normal sexual function and was advised that any erectile issues could often be managed with medication like sildenafil (Viagra).
- Risk estimates vary widely, from 5% to as high as 95%, depending on different sources.

2. Surgeon and hospital choice:
- It is highly recommended to choose a colorectal surgeon who frequently performs this type of surgery, as their experience can reduce the risk of complications.
- Opting for a world-renowned center, such as St Mark’s Hospital, is considered beneficial.

3. Fertility preservation:
- It is wise to bank sperm at a cryopreservation facility before surgery in case fertility is affected afterward.

4. Decision-making factors:
- The potential improvement in quality of life from removing the rectal stump often outweighs the surgical risks, especially when other medical treatments have not worked.
- It is important to discuss all possible complications, anesthesia risks, and postoperative solutions with both the colorectal surgeon and a gastroenterologist.

5. Psychological and social aspects:
- Finding an understanding and accepting partner may be more challenging than dealing with physical function issues. However, medical professionals are generally supportive of ostomates.