Abstract
Introduction
Urogenital dysfunction is a well recognized complication of rectal cancer surgery. The aim of this study was to assess the impact of autonomic nerve preservation (ANP) and lateral node dissection (LND) on male urogenital function after total mesorectal excision for lower rectal cancer.
Methods
We studied, using a questionnaire, preoperative and current urogenital function in 47 male patients who underwent total mesorectal excision with the ANP technique for lower rectal cancer. Patients with and without LND were analyzed separately.
Results
A total of 37 patients (78.7%) (22 patients without LND, 15 with LND) returned the questionnaire. Among the 15 patients with LND, 2 underwent unilateral ANP. One patient without LND had urinary dysfunction preoperatively, and among the other 21 patients only 2 (9.5%) reported minor urinary complications postoperatively. After LND, 5 patients (33%) reported minor complications; there were no severe complications. Among patients who were sexually active prior to the operation, 90% and 70% of patients without LND and 50% and 10% of those with LND maintained sexual activity and ejaculation, respectively. However, 50% of patients who underwent low anterior resection or Hartmann resection without LND and all patients with abdominoperineal resection or LND reported reduced overall sexual satisfaction.
Conclusions
The ANP technique offers the great advantage of maintaining urogenital function after rectal cancer surgery. After LND, although the ANP technique minimized urinary dysfunction, sexual function, particularly ejaculation, was often damaged. Careful follow-up is important even after ANP to improve postoperative sexual satisfaction.
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References
Leveckis J, Boucher NR, Parys BT, et al. Bladder and erectile dysfunction before and after rectal surgery for cancer. Br J Urol 1995;76:752–756
Cunsolo A, Bragaglia RB, Manara G, et al. Urogenital dysfunction after abdominoperineal resection for carcinoma of the rectum. Dis Colon Rectum 1990;33:918–922
Santangelo ML, Romano G, Sassaroli C. Sexual function after resection for rectal cancer. Am J Surg 1987;154:502–504
Fazio VW, Fletcher J, Montague D. Prospective study of the effect of resection of the rectum on male sexual function. World J Surg 1980;4:149–152
Havenga K, Enker WE, Norstein J, et al. Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 1999;25:368–374
Heald RJ, Moran BJ, Ryall RD, et al. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998;133:894–899
Enker WE. Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 1992;127:1396–1401
Havenga K, Enker WE, McDermott C, et al. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 1996;182:495–502
Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction and priapism. In Walsh PC, Retik AB, Vaugham ED, et al., editors. Campbell’s Urology, 8th edition. Philadelphia, Saunders, 2002; pp 1591–1618
Hojo K, Sawada T, Moriya Y. An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 1989;32:128–133
Mori T, Takahashi K, Yasuno M. Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral node dissection. Langenbecks Arch Surg 1998;383:409–415
Morita T, Murata A, Koyama M, et al. Current status of autonomic nerve-preserving surgery for mid and lower rectal cancers: Japanese experience with lateral node dissection. Dis Colon Rectum 2003;46(Suppl):S78–S87
Sugihara K, Moriya Y, Akasu T, et al. Pelvic autonomic nerve preservation for patients with rectal carcinoma: oncologic and functional outcome. Cancer 1996;78:1871–1880
Moriya Y, Sugihara K, Akasu T, et al. Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancer. Eur J Cancer 1995;31A:1229–1232
Pocard M, Zinzindohoue F, Haab F, et al. A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer. Surgery 2002;131:368–372
Nesbakken A, Nygaard K, Bull-Njaa T, et al. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 2000;87:206–210
Kim NK, Aahn TW, Park JK, et al. Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer. Dis Colon Rectum 2002;45:1178–1185
Maas CP, Moriya Y, Steup WH, et al. Radical and nerve-preserving surgery for rectal cancer in The Netherlands: a prospective study on morbidity and functional outcome. Br J Surg 1998;85:92–97
Kontturi M, Larmi TK, Tuononen S. Bladder dysfunction and its manifestations following abdominoperineal extirpation of the rectum. Ann Surg 1974;179:179–182
Watson PC, Williams DI. The urological complications of excision of the rectum. Br J Surg 1952;40:19–28
Shafik A, El-Sibai O. Effect of pelvic floor muscle contraction on vesical and rectal function with identification of puborectalis-rectovesical inhibitory reflex and levator-rectovesical excitatory reflex. World J Urol 2001;19:278–284
Petros PE, Ulmsten U. Role of the pelvic floor in bladder neck opening and closure. I. Muscle forces. Int Urogynecol J Pelvic Floor Dysfunct 1997;8:74–80
Maeda K, Maruta M, Utsumi T, et al. Bladder and male sexual functions after autonomic nerve-sparing TME with or without lateral node dissection for rectal cancer. Tech Coloproctol 2003;7:29–33
Denis L, Griffiths K, Khoury S, et al. Measuring the symptoms and health impact of benign prostatic hyperplasia and its treatments. In Denis L, Griffiths K, Khoury S, et al., editors. 4th International Consultation on Benign Prostatic Hyperplasia. Paris, World Health Organization, 1998;265–280
Rosen RC, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–830
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Kyo, K., Sameshima, S., Takahashi, M. et al. Impact of Autonomic Nerve Preservation and Lateral Node Dissection on Male Urogenital Function after Total Mesorectal Excision for Lower Rectal Cancer. World J. Surg. 30, 1014–1019 (2006). https://doi.org/10.1007/s00268-005-0050-9
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DOI: https://doi.org/10.1007/s00268-005-0050-9