Skip to main content

Advertisement

SpringerLink
Log in

Sexual dysfunction following rectal cancer surgery

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Sexual and urological problems after surgery for rectal cancer are common, multifactorial, inadequately discussed, and untreated. The urogenital function is dependent on dual autonomic sympathetic and parasympathetic innervation, and four key danger zones exist that are at risk for nerve damage during colorectal surgery: one of these sites is in the abdomen and three are in the pelvis. The aim of this study is to systematically review the epidemiology of sexual dysfunction following rectal cancer surgery, to describe the anatomical basis of autonomic nerve-preserving techniques, and to explore the scientific evidence available to support the laparoscopic or robotic approach over open surgery.

Methods

According to the PRISMA guidelines, a comprehensive literature search of studies evaluating sexual function in patients undergoing rectal surgery for cancer was performed in Medline, Scopus, Web of Science, Embase, and Cochrane Central Register of controlled trials.

Results

An increasing number of studies assessing the incidence and prevalence of sexual dysfunction following multimodality treatment for rectal cancer has been published over the last 30 years. Significant heterogeneity in the prevalence of sexual dysfunction is reported in the literature, with rates between 5 and 90%.

Conclusions

There is no evidence to date in favor of any surgical approach (open vs laparoscopic vs robotic). Standardized diagnostic tools should be routinely used to prospectively assess sexual function in patients undergoing rectal surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hendren SK, O’Connor BI, Liu M et al (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242(2):212–223

    Article  PubMed  PubMed Central  Google Scholar 

  2. da Silva GM, Hull T, Roberts PL et al (2008) The effect of colorectal surgery in female sexual function, body image, self-esteem and general health: a prospective study. Ann Surg 248:266–272

    Article  PubMed  Google Scholar 

  3. Sanoff HK, Morris W, Mitcheltree AL et al (2015) Lack of support and information regarding long-term negative effects in survivors of rectal cancer. Clin J Oncol Nurs 19(4):444–448

    Article  PubMed  Google Scholar 

  4. Leon-Carlyle M, Schmocker S, Victor JC et al (2015) Prevalence of physiologic sexual dysfunction is high following treatment for rectal cancer: but is it the only thing that matters? Dis Colon Rectum 58(8):736–742

    Article  PubMed  Google Scholar 

  5. Chorost MI, Weber TK, LEE RJ et al (2000) Sexual dysfunction, informed consent and multimodality therapy for rectal cancer. Am J Surg 179:271–274

    Article  CAS  PubMed  Google Scholar 

  6. Angenete, Asplund D, Andersson J et al (2014) Self reported experience of sexual function and quality after abdominoperineal excision in a prospective cohort. Int J Surg 12(11):1221–1227

    Article  PubMed  Google Scholar 

  7. Tanagho E, McAninch JW. Smith’s general urology, 17th Edition. McGraw-Hill (2007).

  8. Hatzimouratidis K, Eardley I, Giuliano F et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. European Association of Urology 2014.

  9. Allahdadi KJ, Tostes RC, Webb RC (2009) Female sexual dysfunction: therapeutic options and experimental challenges. Cardiovasc Hematol Agents Med Chem 7:260

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses. The PRISMA StatementBMJ 339:b2535

    Google Scholar 

  11. Deeks JJ, Dinnes J, D'Amico R, et al. Evaluating non-randomised intervention studies. International Stroke Trial Collaborative Group; European Carotid Surgery Trial Collaborative Group. Health Technol Assess. 2003;7(27):iii-x, 1–173.

    Article  Google Scholar 

  12. Nesbakken A, Nygaard K, Bull-Njaa T et al (2000) Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 87(2):206–210

    Article  CAS  PubMed  Google Scholar 

  13. Maas CP, Moriya Y, Steup WH et al (2000) A prospective study on radical and nerve-preserving surgery for rectal cancer in the Netherlands. Eur J Surg Oncol 26(8):751–757

    Article  CAS  PubMed  Google Scholar 

  14. Kim NK, Aahn TW, Park JK et al (2002) Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer. Dis Colon Rectum 45(9):1178–1185

    Article  PubMed  Google Scholar 

  15. Maeda K, Maruta M, Utsumi T et al (2003) Bladder and male sexual functions after autonomic nerve-sparing TME with or without lateral node dissection for rectal cancer. Tech Coloproctol 7(1):29–33

    Article  CAS  PubMed  Google Scholar 

  16. Ameda K, Kakizaki H, Koyanagi T et al (2005) The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer. Int J Urol 12(3):256–263

    Article  PubMed  Google Scholar 

  17. Liang JT, Lai HS, Lee PH (2007) Laparoscopic pelvic autonomic nerve-preserving surgery for patients with lower rectal cancer after chemoradiation therapy. Ann Surg Oncol 14(4):1285–1287

    Article  PubMed  Google Scholar 

  18. Perera MT, Deen KI, Wijesuriya SR et al (2008) Sexual and urinary dysfunction following rectal dissection compared with segmental colectomy. Color Dis 10(7):689–693

    Article  CAS  Google Scholar 

  19. Breukink SO, van Driel MF, Pierie JP et al (2008) Male sexual function and lower urinary tract symptoms after laparoscopic total mesorectal excision. Int J Color Dis 23(12):1199–1205

    Article  CAS  Google Scholar 

  20. Asoglu O, Matlim T, Karanlik H et al (2009) Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc 23(2):296–303

    Article  PubMed  Google Scholar 

  21. Jones OM, Stevenson AR, Stitz RW et al (2009) Preservation of sexual and bladder function after laparoscopic rectal surgery. Color Dis 11(5):489–495

    Article  CAS  Google Scholar 

  22. Morino M, Parini U, Allaix ME et al (2009) Male sexual and urinary function after laparoscopic total mesorectal excision. Surg Endosc 23(6):1233–1240

    Article  PubMed  Google Scholar 

  23. Pietrangeli A, Pugliese P, Perrone M et al (2009) Sexual dysfunction following surgery for rectal cancer—a clinical and neurophysiological study. J Exp Clin Cancer Res 17:28–128

    Google Scholar 

  24. Akasu T, Sugihara K, Moriya Y (2009) Male urinary and sexual functions after mesorectal excision alone or in combination with extended lateral pelvic lymph node dissection for rectal cancer. Ann Surg Oncol 16(10):2779–2786

    Article  PubMed  Google Scholar 

  25. Zugor V, Miskovic I, Lausen B et al (2010) Sexual dysfunction after rectal surgery: a retrospective study of men without disease recurrence. J Sex Med 7(9):3199–3205

    Article  PubMed  Google Scholar 

  26. Celentano V, Fabbrocile G, Luglio G et al (2010) Prospective study of sexual dysfunction in men with rectal cancer: feasibility and results of nerve sparing surgery. Int J Color Dis 25(12):1441–1445

    Article  Google Scholar 

  27. Sartori CA, Sartori A, Vigna S et al (2011) Urinary and sexual disorders after laparoscopic TME for rectal cancer in males. J Gastrointest Surg 15(4):637–643

    Article  PubMed  Google Scholar 

  28. Nishizawa Y, Ito M, Saito N et al (2011) Male sexual dysfunction after rectal cancer surgery. Int J Color Dis 26(12):1541–1548

    Article  Google Scholar 

  29. Doeksen A, Gooszen JA, van Duijvendijk P et al (2011) Sexual and urinary functioning after rectal surgery: a prospective comparative study with a median follow-up of 8.5 years. Int J Color Dis 26(12):1549–1557

    Article  Google Scholar 

  30. Kim JY, Kim NK, Lee KY et al (2012) A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 19(8):2485–2493. doi:10.1245/s10434-012-2262-1

    Article  PubMed  Google Scholar 

  31. Den Oudsten BL, Traa MJ, Thong MS et al (2012) Higher prevalence of sexual dysfunction in colon and rectal cancer survivors compared with the normative population: a population-based study. Eur J Cancer 48(17):3161–3170

    Article  CAS  PubMed  Google Scholar 

  32. Milbury K, Cohen L, Jenkins R et al (2013) The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer. Support Care Cancer 21(3):793–802

    Article  PubMed  Google Scholar 

  33. Runkel N, Reiser H (2013) Nerve-oriented mesorectal excision (NOME): autonomic nerves as landmarks for laparoscopic rectal resection. Int J Color Dis 28(10):1367–1375

    Article  Google Scholar 

  34. Contin P, Kulu Y, Bruckner T et al (2014) Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer. Int J Color Dis 29(2):165–175

    Article  Google Scholar 

  35. Attaallah W, Ertekin C, Tinay I et al (2014) High rate of sexual dysfunction following surgery for rectal cancer. Ann Coloproctol 30(5):210–215

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wang G, Wang Z, Jiang Z et al (2016) Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot 8. doi:10.1002/rcs.1725

  37. Adam JP, Denost Q, Capdepont M et al (2016) Prospective and longitudinal study of urogenital dysfunction after proctectomy for rectal cancer. Dis Colon Rectum 59(9):822–830

    Article  PubMed  Google Scholar 

  38. Dulskas A, Samalavicius NE (2016) A prospective study of sexual and urinary function before and after total mesorectal excision. Int J Color Dis 31(6):1125–1130

    Article  Google Scholar 

  39. Andersson J, Abis G, Gellerstedt M et al (2014) Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II). Br J Surg 101(10):1272–1279

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Traa MJ, Orsini RG, Den Oudsten BL et al (2014) Measuring the health-related quality of life and sexual functioning of patients with rectal cancer: does type of treatment matter? Int J Cancer 134(4):979–987

    Article  CAS  PubMed  Google Scholar 

  41. Lee DK, Jo MK, Song K et al (2010) Voiding and sexual function after autonomic-nerve-preserving surgery for rectal cancer in disease-free male patients. Korean J Urol 51(12):858–862

    Article  PubMed  PubMed Central  Google Scholar 

  42. Stamopoulos P, Theodoropoulos GE, Papailiou J et al (2009) Prospective evaluation of sexual function after open and laparoscopic surgery for rectal cancer. Surg Endosc 23(12):2665–2674

    Article  PubMed  Google Scholar 

  43. Heriot AG, Tekkis PP, Fazio VW et al (2005) Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive model. Ann Surg 242(4):502–510

    PubMed  PubMed Central  Google Scholar 

  44. Sterk P, Shekarriz B, Günter S et al (2005) Voiding and sexual dysfunction after deep rectal resection and total mesorectal excision: prospective study on 52 patients. Int J Color Dis 20(5):423–427

    Article  Google Scholar 

  45. Marijnen CA, van de Velde CJ, Putter H et al (2005) Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 23(9):1847–1858

    Article  PubMed  Google Scholar 

  46. Quah HM, Jayne DG, Eu KW et al (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89(12):1551–1556

    Article  CAS  PubMed  Google Scholar 

  47. Pocard M, Zinzindohoue F, Haab F et al (2002) A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer. Surgery 131(4):368–372

    Article  PubMed  Google Scholar 

  48. Maurer CA, Z'Graggen K, Renzulli P et al (2001) Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery. Br J Surg 88(11):1501–1505

    Article  CAS  PubMed  Google Scholar 

  49. Mannaerts GH, Schijven MP, Hendrikx A et al (2001) Urologic and sexual morbidity following multimodality treatment for locally advanced primary and locally recurrent rectal cancer. Eur J Surg Oncol 27(3):265–272

    Article  CAS  PubMed  Google Scholar 

  50. Bregendahl S, Emmertsen KJ, Lindegaard JC et al (2015) Urinary and sexual dysfunction in women after resection with and without preoperative radiotherapy for rectal cancer: a population-based cross-sectional study. Color Dis 17(1):26–37

    Article  CAS  Google Scholar 

  51. Lindsey I, Guy RJ, Warren BF et al (2000) Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 87(10):1288–1299

    Article  CAS  PubMed  Google Scholar 

  52. Celentano V (2017) Nerve-sparing surgery and sexual and urinary dysfunction after multimodality treatment for rectal cancer. Tech Coloproctol. doi:10.1007/s10151-017-1592-1 [Epub ahead of print]

    PubMed  Google Scholar 

  53. Applewhite MK, White MG, James BC, Abdulrasool L, Kaplan EL, Angelos P, Grogan RH (2017) Ultrasonic, bipolar, and integrated energy devices: comparing heat spread in collateral tissues. J Surg Res 207:249–254

    Article  PubMed  Google Scholar 

  54. Kourambas J, Angus DG, Hosking P et al (1998) A histological study of Denonvilliers' fascia and its relationship to the neurovascular bundle. Br J Urol 82(3):408–410

    Article  CAS  PubMed  Google Scholar 

  55. Lindsey I, Warren BF, Mortensen NJ (2005) Denonvilliers’ fascia lies anterior to the fascia propria and rectal dissection plane in total mesorectal excision. Dis Colon Rectum 48(1):37–42

    Article  PubMed  Google Scholar 

  56. Heald RJ, Moran BJ, Brown G et al (2004) Optimal total mesorectal excision for rectal cancer is by dissection in front of Denonvilliers’ fascia. Br j Surg 91(1):121–123

    Article  CAS  PubMed  Google Scholar 

  57. Rs L, Yang TX, Chua TC (2014) Postoperative bladder and sexual function in patients undergoing surgery for rectal cancer: a systematic review and meta-analysis of laparoscopic versus open resection of rectal cancer. Tech Coloproctol 18(11):993–1002

    Article  Google Scholar 

  58. Celentano V, Finch D, Forster L, Robinson JM, Griffith JP (2015) Safety of supervised trainee-performed laparoscopic surgery for inflammatory bowel disease. Int J Color Dis 30(5):639–644

    Article  Google Scholar 

  59. Giglio MC, Celentano V, Tarquini R, Luglio G, De Palma GD, Bucci L (2015) Conversion during laparoscopic colorectal resections: a complication or a drawback? A systematic review and meta-analysis of short-term outcomes. Int J Color Dis 30(11):1445–1455

    Article  Google Scholar 

  60. Ontani H, Tamamori Y, Azuma T et al (2011) A meta-analysis of the short and long term results of randomized controlled trials that compared laparoscopy assisted and conventional open surgery for rectal cancer. J Gastrointest Surg 15(8):1375–1385

    Article  Google Scholar 

  61. Vennix S, Pelzers L, Bouvy N et al. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. (2014) Apr 15;(4).

  62. Jayne DG, Brown JM, Thorpe H et al (2005) Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg 92(9):1124–1132

    Article  CAS  PubMed  Google Scholar 

  63. Nitori N, Hasegawa H, Ishii Y et al (2008) Sexual function in men with rectal and rectosigmoid cancer after laparoscopic and open surgery. Hepato-Gastroenterology 55(85):1304–1307

    CAS  PubMed  Google Scholar 

  64. Hur H, Bae SU, Kim NK et al (2013) Comparative study of voiding and male sexual function following open and laparoscopic total mesorectal excision in patients with rectal cancer. J Surg Oncol 108(8):572–578

    Article  PubMed  Google Scholar 

  65. Liu Y, Lu XM, Tao KX et al (2016) Anatomical basis and clinical research of pelvic autonomic nerve preservation with laparoscopic radical resection for rectal cancer. J Huazhong Univ Sci Technolog Med Sci 36(2):211–214

    Article  PubMed  Google Scholar 

  66. D'Annibale A, Pernazza G, Monsellato I et al (2013) Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27(6):1887–1895

    Article  PubMed  Google Scholar 

  67. Park SY, Choi GS, Park JS et al (2014) Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methodsfor the treatment of rectal cancer: a case-matched comparison. World J Surg 38(7):1834–1842. doi:10.1007/s00268-013-2419-5

    Article  PubMed  Google Scholar 

  68. Patriti A, Ceccarelli G, Bartoli A et al (2009 Apr-Jun) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS 13(2):176–183

    PubMed  PubMed Central  Google Scholar 

  69. Song PH, Yun SM, Kim JH, Moon KH (2010) Comparison of the erectile function in male patients with rectal cancer treated by preoperative radiotherapy followed by surgery and surgery alone. Int J Color Dis 25:619–624

    Article  Google Scholar 

  70. Prabhudesai AG, Cornes P, Glees JP, Kumar D (2005) Long-term morbidity following short-course, preoperative radiotherapy and total mesorectal excision for rectal cancer. Surgeon 3:347–351

    Article  CAS  PubMed  Google Scholar 

  71. Bonnel C, Parc YR, Pocard M, Dehni N, Caplin S, Parc R, Tiret E (2002) Effects of preoperative radiotherapy for primary resectable rectal adenocarcinoma on male sexual and urinary function. Dis Colon Rectum 45(7):934–939

    Article  PubMed  Google Scholar 

  72. Pietrzak L, Bucko K, Nowacki MP et al (2007) Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomised trial. Radiother Oncol 84(3):217–225

    Article  PubMed  Google Scholar 

  73. McLachlan SA, Fisher RG, Zalcberg J et al (2016) The impact on health-related quality of life in the first 12 months: a randomised comparison of preoperative short-course radiation versus long-course chemoradiation for T3 rectal cancer (Trans-Tasman Radiation Oncology Group Trial 01.04). Eur J Cancer 55:15–26

    Article  PubMed  Google Scholar 

  74. Kneist W. Minimal invasive pelvic neuromonitoring—technical demands and requirements. Biomed Tech (Berl) 2013 (s1).

  75. Kneist W et al (2007) Intraoperative electrostimulation objectifies the assessment of functional nerve preservation after mesorectal excision. Int J Color Dis 22(6):675–682

    Article  CAS  Google Scholar 

  76. Dw K, Kneist W et al (2016) Electrophysiology-based quality assurance of nerve-sparing in laparoscopic rectal cancer surgery: is it worth the effort? Surg Endosc 30(10):4525–4532

    Article  Google Scholar 

  77. Kauff DW, Kneist W et al (2013) Evaluation of two-dimensional intraoperative neuromonitoring for predicting urinary and anorectal function after rectal cancer surgery. Int J Color Dis 28(5):659–664

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Southwick Hill Rd, Portsmouth, PO6 3LY, UK

    V Celentano

  2. Department of Colorectal Surgery, University College London Hospitals, 235 Euston Rd, Bloomsbury, London, NW1 2BU, UK

    R Cohen & M Chand

  3. Department of Surgery, St. Mark’s Hospital, Harrow, UK

    J Warusavitarne & O Faiz

Authors
  1. V Celentano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Warusavitarne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O Faiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Chand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V Celentano.

Ethics declarations

Conflict of interest statement

The authors declare that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Celentano, V., Cohen, R., Warusavitarne, J. et al. Sexual dysfunction following rectal cancer surgery. Int J Colorectal Dis 32, 1523–1530 (2017). https://doi.org/10.1007/s00384-017-2826-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2826-4

Keywords

Search

Navigation