Bladder and sexual dysfunction after mesorectal excision for rectal cancer

Nesbakken, Arild; Nygaard, K; Bull-Njaa, T.; Carlsen, Erik; Eri, Lars M.

doi:10.1046/j.1365-2168.2000.01357.x

Cited by 266 publications

(197 citation statements)

References 22 publications

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“…According to prospective studies, ED and EJD rates after TME, respectively, vary from 4% to 28% and 5% to 8% [16][17][18][19], so the results with respect to postoperative sexual functioning vary widely between surgeons and institutions.…”

Section: Discussionmentioning

confidence: 99%

Male sexual function and lower urinary tract symptoms after laparoscopic total mesorectal excision

Breukink

Driel

Pierie

et al. 2008

Int J Colorectal Dis

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Background and aims The aim of this study was to investigate sexual function and the presence of lower urinary tract symptoms (LUTS) in male patients with rectal cancer following short-term radiotherapy and laparoscopic total mesorectal excision (LTME) by physical and psychological measurements. Materials and methods Sexual function and LUTS were assessed by the use of questionnaires [International Index of Erectile Function (IIEF), International Prostate Symptom Score]. Sexual function was further assessed by the use of pharmaco duplex ultrasonography of the cavernous arterial blood flow and nocturnal penile tumescence and rigidity monitoring (NPTR). All investigations were performed prior to the start of preoperative radiotherapy and 15 months after surgery. Results Nine patients (mean age 60 years) participated. Erectile function was maintained in 71% and ejaculation function in 89%. Compared with pre-operative scores on the IIEF, a significant deterioration in intercourse satisfaction was seen following radiotherapy and LTME (7.9 vs 10.3, p=0.042), but overall satisfaction remained unchanged (8.0 vs 7.0, p=0.246). NPTR parameters (duration of erectile episodes, duration of tip rigidity ≥60%) decreased following radiotherapy and LTME. Patients reported a deterioration in micturition frequency (2.0 vs 1.0, p=0.034) and quality of life due to urinary symptoms (8.0 vs 1.8, p=0.018). Conclusion Based on these first preliminary findings, data suggest that 15 months after short-term radiotherapy and LTME in men with rectal cancer, objectively assessed sexual dysfunction was considerable, but overall sexual satisfaction had not changed.

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Section: Discussionmentioning

confidence: 99%

Male sexual function and lower urinary tract symptoms after laparoscopic total mesorectal excision

Breukink

Driel

Pierie

et al. 2008

Int J Colorectal Dis

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“…8 To make the confusion greater, some support the idea that specific identification of the autonomic nerves is not essential during TME as dissection on the mesorectal fascia would spare the nerves automatically. 12 This assumes that the mesorectal fascia is a continuous structure. However, one could question if this is really the case.…”

Section: Introductionmentioning

confidence: 99%

Whole mount microscopic sections reveal that Denonvilliers' fascia is one entity and adherent to the mesorectal fascia; implications for the anterior plane in total mesorectal excision?

Kraima¹,

West²,

Treanor³

et al. 2015

European Journal of Surgical Oncology (EJSO)

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ReuseUnless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. Abstract AimExcellent understanding of the arrangement of fasciae and nerves surrounding the rectum is necessary for total mesorectal excision (TME). However, the fasciae anterolateral to the mesorectum and surrounding the low-rectum are still poorly understood. We studied the perirectal fascia along the complete length of the rectum in en-bloc cadaveric specimens and the University Medical Center of Utrecht (UMCU) pelvic dataset, and describe implications for TME. MethodsFour donated human adult cadaveric specimens (two males, two females) were obtained through the Leeds GIFT Research Tissue Programme. Paraffin-embedded blocks were produced and serially sectioned at 50 and 250 m intervals. Whole mount sections were stained with haematoxylin & eosin, Masson's trichrome and Millers' elastin. Additionally, the UMCU pelvic dataset including digitalised cryosections of a female pelvis in three axes, was studied. ResultsMultiple fascial layers surrounded the upper rectum. In the 'holy plane' of TME, laminae merged with the mesorectal and parietal fascia. Nerves ran directly laterally to the mesorectal fascia. More caudally, the mesorectal fascia approached the longitudinal layer of the rectal muscularis propria 3 with the neurovascular bundles situated anterolaterally. The mesorectal fascia had a variable appearance in terms of thickness and completeness, which was most prominent anterolaterally. ConclusionOptimal TME requires dissection on the mesorectal fascia to preserve the nerves. Rectal surgeons are challenged in doing so as the mesorectal fascia varies in thickness and is often absent in some areas. More caudally, a wider excision may be needed to avoid incomplete specimens.4

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“…8 To make the confusion greater, some support the idea that specific identification of the autonomic nerves is not essential during TME as dissection on the mesorectal fascia would spare the nerves automatically. 12 This is based on the assumption that the mesorectal fascia is a continuous structure. However, one could question if this is really the case.…”

Section: Introductionmentioning

confidence: 99%

Understanding the surgical pitfalls in total mesorectal excision: Investigating the histology of the perirectal fascia and the pelvic autonomic nerves

Kraima

West

Treanor

et al. 2015

European Journal of Surgical Oncology (EJSO)

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AimExcellent understanding of the arrangement of fasciae and nerves surrounding the rectum is necessary for total mesorectal excision (TME). However, the fasciae anterolateral to the mesorectum and surrounding the low-rectum are still poorly understood. We studied the perirectal fascia along the complete length of the rectum in en-bloc cadaveric specimens and the University Medical Center Utrecht (UMCU) pelvic dataset, and describe implications for TME. MethodsFour donated human adult cadaveric specimens (two males, two females) were obtained through the Leeds GIFT Research Tissue Programme. Paraffin-embedded blocks were produced and serially sectioned at 50 and 250 m intervals. Whole mount sections were stained with haematoxylin & eosin,Masson's trichrome and Millers' elastin. Additionally, the UMCU pelvic dataset including digitalised cryosections of a female pelvis in three axes was studied. ResultsMultiple fascial layers surrounded the upper rectum. In the 'holy plane' of TME, laminae merged with the mesorectal and parietal fascia. Nerves ran directly laterally to the mesorectal fascia. More caudally, the mesorectal fascia approached the longitudinal layer of the rectal muscularis propria with the neurovascular bundles situated anterolaterally. The mesorectal fascia had a variable appearance in terms of thickness and completeness, which was most prominent anterolaterally. Conclusion 3Optimal TME requires dissection on the mesorectal fascia to preserve the nerves. Rectal surgeons are challenged in doing so as the mesorectal fascia varies in thickness and is often absent in some areas. More caudally, a wider excision may be needed to avoid incomplete specimens.4

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Bladder and sexual dysfunction after mesorectal excision for rectal cancer

Abstract: Mesorectal excision for rectal cancer resulted in a low frequency of serious bladder and sexual dysfunction.

Cited by 266 publications

References 22 publications

Male sexual function and lower urinary tract symptoms after laparoscopic total mesorectal excision

Male sexual function and lower urinary tract symptoms after laparoscopic total mesorectal excision

Whole mount microscopic sections reveal that Denonvilliers' fascia is one entity and adherent to the mesorectal fascia; implications for the anterior plane in total mesorectal excision?

Understanding the surgical pitfalls in total mesorectal excision: Investigating the histology of the perirectal fascia and the pelvic autonomic nerves

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