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Impotence after mesorectal and close rectal dissection for inflammatory bowel disease

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Diseases of the Colon & Rectum

Abstract

PURPOSE: Close rectal dissection is a surgical technique used by some surgeons in inflammatory bowel disease. It is performed within the mesorectum, close to the rectal muscle wall, with the aim of minimizing damage to the pelvic sexual nerves. Other surgeons dissect in the more anatomical mesorectal plane. Our aim was to determine whether close rectal dissection is more protective of the pelvic sexual nerves than mesorectal dissection. METHOD: Patients undergoing surgery for inflammatory bowel disease were entered prospectively into a database. Male patients were mailed a standardized, validated, urologic impotence questionnaire: the International Index of Erectile Function. RESULTS: There was an 81 percent response rate. Six of 156 assessable patients were totally impotent (3.8 percent). They were all in the 50-year-old to 70-year-old age group, with no impotence in patients younger than 50 years old. Twenty-one patients complained of minor diminution of erectile function (13.5 percent), where sexual activity was still possible. There was no statistical difference in the rate of complete (2.2 percentvs. 4.5 percent,P=0.67) or partial (13.5 percentvs. 13.3 percent,P=0.99) impotence between close rectal and mesorectal dissection (Fisher's exact test). There were no ejaculatory difficulties. The time elapsed since surgery ranged from 2.7 months to 192.7 months, with a median of 74.5 months. CONCLUSION: Rectal excision for inflammatory bowel disease can be conducted with low rates of impotence. Minor degrees of erectile dysfunction may be more common than currently recognized. We could not demonstrate that close rectal dissection significantly protects the patient from impotence compared with operating in the anatomical mesorectal plane. Age appears to be the most important risk factor for postoperative impotence.

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Authors and Affiliations

  1. From the Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, United Kingdom

    Ian Lindsey (F.R.A.C.S.), Bruce D. George M.S. (F.R.C.S.), Mike G. W. Kettlewell M.A., M.Ch. & Neil J. Mc. C. Mortensen M.D.

Authors
  1. Ian Lindsey
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  2. Bruce D. George M.S.
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  3. Mike G. W. Kettlewell M.A., M.Ch.
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  4. Neil J. Mc. C. Mortensen M.D.
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Additional information

Read at the Royal Society of Medicine, Section of Coloproctology, Short Papers Meeting, London, United Kingdom, November 24, 1999.

Dr. Ian Lindsey is supported by the Colorectal Research Fund.

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Lindsey, I., George, B.D., Kettlewell, M.G.W. et al. Impotence after mesorectal and close rectal dissection for inflammatory bowel disease. Dis Colon Rectum 44, 831–835 (2001). https://doi.org/10.1007/BF02234703

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