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Sexual, urinary, and intestinal dysfunction after rectal surgery: pre-, intra-, and post-operative predictors and trends over time in a single high-volume center

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Abstract

The incidence of long-term complications after rectal surgery varies widely among studies, and data regarding functional sequelae after transanal surgery are lacking. The aim of this study is to describe the incidence and change over time of sexual, urinary, and intestinal dysfunction in a single-center cohort, identifying independent predictors of dysfunction. A retrospective analysis of all rectal resections performed between March 2016 and March 2020 at our institution was conducted. Validated questionnaires were administered to assess post-operative function. Predictors of dysfunction were assessed by univariate and multivariate analysis. Latent class analysis was used to distinguish different risk profile classes. One hundred and forty-five patients were included. Sexual dysfunction at 1 month rose to 37% for both sexes, whereas urinary dysfunction reached 34% in males only. A significant (p < 0.05) improvement in urogenital function was observed between 1 and 6 months only. Intestinal dysfunction increased at 1 month, with no significant improvement between 1 and 12 months. Independent predictors of genitourinary dysfunction were post-operative urinary retention, pelvic collection, and Clavien–Dindo score ≥ III (p < 0.05). Transanal surgery resulted an independent predictor of better function (p < 0.05). Transanal approach, Clavien–Dindo score ≥ III, and anastomotic stenosis were independent predictors of higher LARS scores (p < 0.05). Maximum dysfunction was found at 1 month after surgery. Improvement was earlier for sexual and urinary dysfunction, whereas intestinal dysfunction improved slower and depended on pelvic floor rehabilitation. Transanal approach was protective for urinary and sexual function, although associated with a higher LARS score. Prevention of anastomosis-related complications resulted protective of post-operative function.

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Data Availability

The data that support the findings of this study are available from the corresponding author, upon reasonablerequest.

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Acknowledgements

We thank Nicoletta De Santis for data editing and Elinor Julie Rae Anderson for language editing.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy

    Gaia Masini, Elisa Bertocchi, Giuliano Barugola & Giacomo Ruffo

  2. Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy

    Massimo Guerriero

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  1. Gaia Masini
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  2. Elisa Bertocchi
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  3. Giuliano Barugola
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  4. Massimo Guerriero
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  5. Giacomo Ruffo
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Correspondence to Gaia Masini.

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The authors have no relevant financial or non-financial interests to disclose.

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Ethical approval was waived by the local Ethics Committee of University of Verona in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Masini, G., Bertocchi, E., Barugola, G. et al. Sexual, urinary, and intestinal dysfunction after rectal surgery: pre-, intra-, and post-operative predictors and trends over time in a single high-volume center. Updates Surg 75, 599–609 (2023). https://doi.org/10.1007/s13304-023-01462-2

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