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Sexual- und Blasenfunktion bei Männern nach laparoskopischer totaler mesorektaler Exzision

Male sexual and urinary function after laparoscopic total mesorectal excision

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coloproctology Aims and scope

Zusammenfassung

Fragestellung und Hintergrund

Blasen- und Sexualfunktionsstörungen sind mögliche Komplikationen bei rektalen Tumoroperationen. Diese Studie untersuchte retrospektiv die Häufigkeit solcher Komplikationen nach einer laparoskopischen totalen mesorektalen Exzision (LTME) mit Erhalt der autonomen Nerven.

Patienten und Methodik

Für diese Studie wurde bei 50 Männern unter 75 Jahren, die eine radikale LTME wegen eines mittleren und distalen Karzinoms hatten, ein Follow-up von mindestens 12 Monaten in Form eines Interviews und eines standardisierten Fragebogens zu postoperativen funktionellen Ergebnissen und Lebensqualität durchgeführt.

Ergebnisse

Das sexuelle Verlangen war bei 55,6%, die Fähigkeit zum sexuellen Verkehr bei 57,8% und die Fähigkeit zu Orgasmus und Ejakulation bei 37,8% der Patienten beibehalten. Der Abstand des Karzinoms vom Analrand und adjuvante oder neoadjuvante Behandlungen waren die signifikanten vorhersagenden Faktoren schlechter postoperativer sexueller Funktionen. Insgesamt 7 Patienten (14%) hatten vorübergehende postoperative Blasenfunktionsstörungen; alle wurden medizinisch behandelt. Tumorstadium und Entfernung des Karzinoms vom Analrand waren unabhängig mit dem postoperativen globalen International Prostatic Symptom Score (IPSS) assoziiert. Es wurden keine Unterschiede in der Lebensqualität in Bezug auf die Harnwegsveränderungen beobachtet.

Schlussfolgerung

In dieser Patientenserie reproduzierte oder verbesserte die LTME die Ergebnisse nicht, die in Verbindung mit Sexual- und Blasenfunktionsstörungen in den besten offenen TME-Serien erzielt wurden. Weitere Studien sind notwendig, um die funktionellen Ergebnisse bei Patienten mit Rektumkarzinom zu untersuchen.

Abstract

Purpose

Urinary and sexual dysfunctions are potential complications of rectal surgery for cancer. This study retrospectively evaluated the frequency of such complications after laparoscopic total mesorectal excision (LTME) with autonomic nerve preservation.

Methods

For this study, 50 men younger than 75 years who underwent radical LTME for middle and lower rectal cancer were followed up for at least 12 months. They were interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life.

Results

Sexual desire was maintained by 55.6% of the patients, ability to engage in intercourse by 57.8%, and ability to achieve orgasm and ejaculation by 37.8%. Distance of the tumor from the anal verge and adjuvant or neoadjuvant treatments were significant predictors of poor postoperative sexual function. Seven patients (14%) presented transitory postoperative urinary dysfunction, all of whom were medically treated. Tumor stage and distance from the anal verge were independently associated with the postoperative global International Prostatic Symptom Score (IPSS). No urinary-related differences in quality of life were observed.

Conclusions

In this series, LTME did not reproduce or improve on sexual and urinary dysfunction outcomes obtained in the best open TME series. Further trials are needed to evaluate functional outcome in rectal cancer patients.

Purpose

This study was designed to confirm the safety of not removing small adenoma in patients who undergo colorectal cancer surgery.

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Danksagung

Die Autoren danken Riccardo Ragona, M.D., Abteilung für Strahlentherapie, Universität Turin, Italien, für seine Hilfe bei der statistischen Datenevaluation.

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Authors and Affiliations

  1. Chirurgia Generale II, Center for Minimally Invasive Surgery, Department of Surgery, University of Turin, C.so A. M. Dogliotti, 14, 10126, Torino, Italien

    M. Morino, M.E. Allaix, G. Monasterolo & C. Garrone

Authors
  1. M. Morino
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  2. M.E. Allaix
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  3. G. Monasterolo
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  4. C. Garrone
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Corresponding author

Correspondence to M. Morino.

Additional information

Übersetzter Nachdruck: Morino M, Parini U, Allaix M, Monasterolo G, Brachet Contul R, Garrone C. Male sexual and urinary function after laparoscopic total mesorectal excision. Surg Endosc 2009;23:1233–1240.

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Morino, M., Allaix, M., Monasterolo, G. et al. Sexual- und Blasenfunktion bei Männern nach laparoskopischer totaler mesorektaler Exzision. coloproctology 32, 23–29 (2010). https://doi.org/10.1007/s00053-010-0065-z

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  • DOI: https://doi.org/10.1007/s00053-010-0065-z

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