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

Abstract

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.

Urinary Dysfunction After Surgical Treatment for Rectal Cancer

“…Those symptoms are usually associated with mild pelvic neural injury compared to the obstructive symptoms (6,27) . Similar findings were described by Sartori et al (30) and Breukink et al (4) , who reported nocturia and increased urinary frequency, respectively, as the most prevalent symptoms. In the present study, one of the patients exhibited severe obstructive symptoms of urinary retention after surgery and required indwelling catheterisation.…”

“…Some studies (16,25,29) compared laparoscopy versus laparotomy and observed functional impairment in the postoperative period, particularly in the sexual area, with impaired male erectile function when video laparoscopy was used. Regarding urinary function, most authors did not find significant impairment among laparoscopic surgeries (4,16,23,26) . The results reported by McGlone et al (23) are significantly favorable to the minimally invasive approach; the authors emphasised the advantages afforded by laparoscopy for the preservation of pelvic function.…”

Prospective evaluation of sexual function after open and laparoscopic surgery for rectal cancer

“…Four studies compared laparoscopic procedures with open surgery for rectal cancer [15,17,22,23], and three studies used the IIEF score as an assessment tool [15,17,18]. Sexual function at different postoperative time points was reported in two studies [15,23], but only one was a prospective study [15].…”

“…Slowly accumulating and rather controversial is the information regarding the effect of laparoscopic rectal surgery on sexual function after rectal cancer surgery [15,17,18,[22][23][24][25]. Four studies compared laparoscopic procedures with open surgery for rectal cancer [15,17,22,23], and three studies used the IIEF score as an assessment tool [15,17,18].…”

“…The International Index of Erectile Function (IIEF), an internationally recognized, well-structured questionnaire for evaluating sexual function, has been used recently by relatively few studies dealing with the sexual dysfunction after rectal cancer surgery [4,[14][15][16][17][18]. Information on the assessment of sexual dysfunction has been derived by single time point data obtained from the IIEF questionnaire [4,[14][15][16][17][18].…”