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Pudendal Nerve Terminal Motor Latency in Patients With or Without Soiling 5 Years or more after Low Anterior Resection for Lower Rectal Cancer

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Abstract

Background

To clarify the neurological function with respect to external anal sphincter (EAS) muscles in patients with or without soiling after low anterior resection (LAR) for lower rectal cancer, we examined the terminal motor latency in the pudendal motor nerves (PNTML).

Materials and Methods

Thirty-eight patients after LAR for lower rectal cancer were studied electrophysiologically and compared with 30 healthy volunteers as controls (19 men and 11 women, aged 44 to 76 years of age, with a mean age of 65.5 years). Patients after LAR were divided into two groups [18 patients with soiling (12 men and 6 women, aged 51 to 77 years with a mean age of 64.8 years), 20 patients without soiling (13 men and 7 women, aged 47 to 75 years with a mean age of 62.1 years)]. The mean follow-up time from LAR was 67.2 months (range 60–84 months). Bilateral (left-sided and right-sided) PNTML tests were performed on all patients in order to measure the latency of the response in the bilateral EAS muscle following digitally directed transrectal pudendal nerve stimulation.

Results

The distance from the anal verge to the level of anastomosis in patients with soiling (mean, 2.2 cm) was significantly shorter than that in patients without soiling (mean, 4.1 cm) (P < 0.05). Conduction delay of the bilateral PNTML in patients with soiling was longer than that in patients without soiling and normal subjects, significantly (P < 0.01, respectively). There was no significant difference between the right-sided and left-sided PNTML.

Conclusions

These findings support the hypothesis that soiling after LAR may be partially caused by damage to the bilateral pudendal motor nerves.

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References

  1. Vassilakis JS, Pechlivanides G, Zoras OJ, et al. Anorectal function after low anterior resection of the rectum. Int J Colorect Dis 1995;10:101–106

    Article  CAS  Google Scholar 

  2. Adachi Y, Kakisaka K, Sato K, et al. Factors influencing bowel function after low anterior resection and sigmoid colectomy. Hepato-Gastroenterology 2000;47:155–158

    PubMed  CAS  Google Scholar 

  3. Rasmussen OO, Petersen IK, Christiansen J. Anorectal function following low anterior resection. Colorectal Dis 2003;5:258–261

    Article  PubMed  CAS  Google Scholar 

  4. Mochiki E, Nakabayashi T, Suzuki H, et al. Barostat examination of proximal site of the anastomosis in patients with rectal cancer after low anterior resection. World J Surg 2001;25:1377–1382

    PubMed  CAS  Google Scholar 

  5. Oya M, Sugamata Y, Komatsu J, et al. Poor neorectal evacuation as a cause of impaired defecatory function after low anterior resection: a study using scintigraphic assessment. Surg Today 2002;32:111–117

    Article  PubMed  Google Scholar 

  6. Iizuka I, Koda K, Seike K, et al. Defecatory malfunction caused by motility disorder of the neorectum after anterior resection for rectal cancer. Am J Surg 2004;188:176–180

    Article  PubMed  Google Scholar 

  7. Pfeifer J, Salanga VD, Agachan F, et al. Variation in pudendal nerve terminal motor latency according to disease. Dis Colon Rectum 1997;40:79–83

    Article  PubMed  CAS  Google Scholar 

  8. Otto IC, Ito K, Hibi K, et al. Causes of rectal incontinence after sphincter-preserving operations for rectal cancer. Dis Colon Rectum 1996;39:1423–1427

    Article  PubMed  CAS  Google Scholar 

  9. Herman RM, Richter P, Walega P, et al. Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Colorectal Dis 2001;16:370–376

    Article  PubMed  CAS  Google Scholar 

  10. Ho YH, Seow-Choen F, Tan M. Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized control trial. World J Surg 2001;25:876–881

    Article  PubMed  CAS  Google Scholar 

  11. Tunoda A, Shibusawa M, Tanizaki H, Kusano M. Hypogastric nerve preservation does not increase local recurrence after surgical treatment of rectal carcinoma. Hepato-Gastroenterology 2004;51:1354–1357

    Google Scholar 

  12. Carlo R, Grillo E, Parello A, et al. Sacral neuromodulation in treatment of fecal incontinence following anterior resection and chemoradiation for rectal cancer. Dis Colon Rectum 2005;48:1027–1036

    Article  Google Scholar 

  13. Di Mattio G, Mascagni D, Zeri KP, et al. Evaluation of function after surgery for rectal cancer. J Surg Oncol 2000;74:11–14

    Article  Google Scholar 

  14. Chatwin NAM, Ribordy M, Givel JC. Clinical outcomes and quality of life after low anteror resection for rectal cancer. Eur J Surg 2002;168:297–301

    Article  PubMed  Google Scholar 

  15. Guren MG, Eriksen MT, Wiig JN, et al. Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol 2005;31:735–742

    Article  PubMed  CAS  Google Scholar 

  16. Rao SS, Hatfield R, Soffer E, et al. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 1999;94:773–783

    Article  PubMed  CAS  Google Scholar 

  17. Tomita R, Igarashi S, Ikeda T, et al. A pathophysiological study using anorectal manometry on patients with or without soiling 5 years or more after low anterior resection for lower rectal cancer. Hepato-Gastroenterology (in press)

  18. Tomita R, Kurosu Y, Isozumi M, et al. Terminal motor latency in the pudendal nerve after colectomy with mucosal proctectomy and ileal J pouch anastomosis for ulcerative colitis. Surg Today 1995;25:187–189

    Article  PubMed  CAS  Google Scholar 

  19. Vaccaro CA, Cheong DM, Wexner SD, et al. Pudendal neuropathy in evacuatory disorders. Dis Colon Rectum 1995;38:166–171

    Article  PubMed  CAS  Google Scholar 

  20. Tomita R, Kurosu Y, Munakata K: Electrophysiologic assessments in pudendal and sacral motor nerves after ileal J pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli. Dis Colon Rectum 0996; 39:410–415

  21. Tetzschner T, Sorensen M, Rasmussen OO, et al. Reliability of pudendal nerve terminal motor latency. Int J Colorect Dis 1997;12:280–284

    Article  CAS  Google Scholar 

  22. Yip B, Barrett RC, Coller JA, et al. Pudendal nerve terminal motor latency testing: assessing the eductional learning curve—can we teach our own? Dis Colon Rectum 2002;45:184–187

    Article  PubMed  Google Scholar 

  23. Sangwan YP, Coller JA, Barrett RC, et al. Unilateral pudendal neuropathy. Dis Colon Rectum 1996;39:249–251

    Article  PubMed  CAS  Google Scholar 

  24. Voyvodic F, Schloithe AC, Wattchow DA, et al. Delayed pudendal nerve conduction and endosonographic appearance of the anal sphincter complex. Dis Colon Rectum 2000;43:1689–1694

    Article  PubMed  CAS  Google Scholar 

  25. Leroi AM, Dorival MP, Lecouturier MF, et al. Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Dis Colon Rectum 1999;42:762–769

    Article  PubMed  CAS  Google Scholar 

  26. Hill J, Hosker G, Kiff ES. Pudendal nerve terminal motor latency measurements: what they do and do not tell us. Br J Surg 2002;89:1268–1269

    Article  PubMed  CAS  Google Scholar 

  27. Rieger NA, Sarre RG, Saccone GTP, et al. Correlation of pudendal nerve terminal motor latency with the results of anal manometry. Int J Colorectal Dis 1997;12:303–307

    Article  PubMed  CAS  Google Scholar 

  28. Suilleabhain CBO, Horgan AF, McEnroe L, et al. The relationship of pudendal nerve terminal motor latency to squeeze pressure in patients with idiopathic fecal incontinence. Dis Colon Rectum 2001;44:666–671

    Article  PubMed  CAS  Google Scholar 

  29. Miller R, Bartolo DC, Orrom WJ, et al. Improvement of anal sensation with preservation of the anal transition zone after ileoanal anastomosis for ulcerative colitis. Dis Colon Rectum 1990;33:414–418

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Nippon Dental University School of Dentistry at Tokyo, 2-3-16 Fujimi Chiyoda-ku, Tokyo, 102-8158, Japan

    Ryouichi Tomita MD, PhD

  2. First Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi Itabashi-ku, Tokyo, 173-0032, Japan

    Ryouichi Tomita MD, PhD, Seigo Igarashi MD, Taro Ikeda MD, Tsugumichi Koshinaga MD, Shigeru Fujisaki MD & Katsuhisa Tanjoh MD

Authors
  1. Ryouichi Tomita MD, PhD
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  2. Seigo Igarashi MD
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  3. Taro Ikeda MD
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  4. Tsugumichi Koshinaga MD
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  5. Shigeru Fujisaki MD
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  6. Katsuhisa Tanjoh MD
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Correspondence to Ryouichi Tomita MD, PhD.

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Tomita, R., Igarashi, S., Ikeda, T. et al. Pudendal Nerve Terminal Motor Latency in Patients With or Without Soiling 5 Years or more after Low Anterior Resection for Lower Rectal Cancer. World J. Surg. 31, 403–408 (2007). https://doi.org/10.1007/s00268-006-0149-7

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  • DOI: https://doi.org/10.1007/s00268-006-0149-7

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