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Preserving Sexual Function and Continence during Radical Rectal Surgery

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Functional Urologic Surgery in Neurogenic and Oncologic Diseases

Part of the book series: Urodynamics, Neurourology and Pelvic Floor Dysfunctions ((UNPFD))

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Abstract

Since the experience reported by Heald, radical rectal surgery has dramatically changed in its functional and oncological outcomes. The identification of the so called “mesorectum” and the importance of its proper fascia as an anatomical plane to be dissected and respected during radical surgery led to the standardization of a new surgical technique, the Total Mesorectal Excision (TME). Traditionally, rectal cancer surgery is affected by high risk of sexual and urinary dysfunction, mainly related to patient, pathology and preoperative radiotherapy. Despite this, during accurate TME with respect of surgical planes, it is possible to preserve the pelvic autonomic nerves, as it is for hypogastric plexus during dissection and division of the inferior mesenteric artery. Today, the possibility to use mini-invasive techniques (laparoscopy and robotic surgery) can improve both oncologic and functional results, mainly by magnification of images and more accurate dissection. Even so, there is still lack of conclusive results regarding the impact of new technologies in preserving sexual and urinary functionality after rectal cancer surgery, and this seems mainly due to: heterogeneity of population, lack of prospective trials on this focus, the role of preoperative radiotherapy.

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Author information

Authors and Affiliations

  1. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy

    Giuseppe Cavallaro

  2. Surgery and Advanced Oncologic Therapies Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy

    Davide Cavaliere

  3. Oncologic Surgery Unit, IRCCS San Martino Institute, Genoa, Italy

    Stefano Scabini

Authors
  1. Giuseppe Cavallaro
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  2. Davide Cavaliere
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  3. Stefano Scabini
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Corresponding author

Correspondence to Giuseppe Cavallaro .

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Editors and Affiliations

  1. Dept Medico-Surgical Sci&Biotechnologies, Sapienza University of Rome, Rome, Italy

    Antonio Carbone

  2. Dept Medico-Surgical Sci&Biotechnologies, Sapienza University of Rome, Rome, Italy

    Giovanni Palleschi

  3. Dept Medico-Surgical Sci&Biotechnologies, Sapienza University of Rome, Rome, Italy

    Antonio Luigi Pastore

  4. Urologic Surgery, Max Fourestier Hospital, Nanterre, France

    Aurel Messas

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Cavallaro, G., Cavaliere, D., Scabini, S. (2016). Preserving Sexual Function and Continence during Radical Rectal Surgery. In: Carbone, A., Palleschi, G., Pastore, A., Messas, A. (eds) Functional Urologic Surgery in Neurogenic and Oncologic Diseases. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-319-29191-8_8

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  • DOI: https://doi.org/10.1007/978-3-319-29191-8_8

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