Elsevier

Surgery

Volume 131, Issue 4, April 2002, Pages 368-372
Surgery

Original Communications
A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer*

https://doi.org/10.1067/msy.2002.122371Get rights and content

Abstract

Background. Oncologic resection of rectal cancer has been reported to be associated with a significant (10%-60%) rate of sexual and urinary dysfunction. We hypothesize that curative total mesorectal excision (TME) with autonomic nerve preservation (ANP) can be done with high rates of preservation of such function. Study Design. We studied prospectively preoperative and postoperative urinary and sexual function in patients who had sphincter-preserving operations for rectal carcinoma without preoperative irradiation. Standardized questionnaires were used preoperatively and postoperatively, including the International Prostatic Symptom Score and a score of quality of urinary function satisfaction. Urodynamic evaluation was performed preoperatively and 3 months after the operation. The sexual results were evaluated after 1 year. Results. Twenty patients, 13 men and 7 women, had TME, with ANP technique. Fourteen patients had coloanal anastomosis, 4 had a stapled colorectal anastomosis, and 2 had an ileoanal anastomosis. In all patients, hypogastric and sacral splanchnic nerves were identified and preserved. There was no mortality. Tumors are graded by Astler-Coller classification: A1 in 3 cases, A2 in 3, B1 in 7, B2 in 2, C2 in 1, and D in 1. There was no difference in preoperative and postoperative urinary function, International Prostatic Symptom Score, or urodynamic results, nor in the results of the quality of urinary function questionnaire. Four of the 7 women (69%) were sexually active before undergoing the surgical procedure. Sexual activity and ability to achieve orgasm was unchanged in these women. No dyspareunia was reported. Nine of the 13 men (69%) were sexually potent in the preoperative period. Sexual activity and potency were unchanged in these men. Retrograde ejaculation was reported in 1 man who previously had had normal antegrade ejaculation. After 3 months, 4 patients reported a reduced rigidity of erection, returning to normal by 1 year. Conclusions. The authors conclude that TME and ANP for cancer limited to the mesorectum do not impair urinary and sexual function. (Surgery 2002;131:368-72.)

Section snippets

Patients and methods

Between March 1996 and April 1997, all consecutive patients who underwent operations for rectal carcinoma in our department were evaluated for inclusion in the study. All those undergoing TME with sphincter preservation were eligible. Patients who had preoperative radiotherapy, prior rectal operations, APR, or no preoperative urodynamic assessment available were excluded. Twenty-five patients were initially included in the study. Five patients were subsequently excluded, 2 because of incomplete

Urinary function

Four days after operation, the mean residual volume after micturation was 20 mL (range 0-40 mL), and the supra-pubic catheter was removed for all the patients on the fifth postoperative day.

Questionnaire results are listed in Table I and urodynamic results listed in Table II.

. Urinary function preoperative and 3 months postoperative according to questionnaire

SymptomsPreoperative n = 20Postoperative n = 20P value
Difficulty emptying bladder10% (n = 2)10% (n = 2)ns
Feeling of incomplete bladder

Discussion

The results of this prospective study confirm that TME can be performed with ANP for patients with rectal cancer confined to the mesorectum. Our aim was to study the best functional result achievable after anterior resection with TME, and we selected only patients with small tumors who did not require preoperative radiotherapy. None of our patients had direct lateral pelvic side wall involvement requiring nerve resection. Our stringent inclusion criteria explain the relatively small numbers in

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*

Reprint requests: Emmanuel Tiret, MD, Department of Surgery, Hôpital Saint-Antoine, 184 rue du faubourg Saint-Antoine, 75012 Paris, France.

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