Sexual and urinary dysfunction after proctectomy for rectal cancer

Abstract

Sexual and urinary dysfunction occur frequently after rectal surgery. Total mesorectal excision (TME) is currently the optimal technique for resection of rectal cancer, providing superior carcinological and functional outcomes. Age, pre-operative radiation therapy, abdominoperineal resection, and surgery which fails to respect the "sacred planes" of TME are the four major risk factors for post-operative sexual and urinary sequelae. In the era of TME, postoperative sexual dysfunction ranges from 10-35%, depending on the scores used to assess it, while urinary sequelae have decreased to less than 5%. The place of laparoscopic surgery remains to be defined, particularly with respect to these complications. It is essential to inform the patient pre-operatively about the possibility of such disorders not only for patient informed consent but also to help with correct post-operative management of the problem. Management is multifaceted, and includes psychological, pharmacological, and sometimes surgical therapy.

Phosphodiesterase-5 Inhibitors and Vacuum Erection Device for Penile Rehabilitation After Laparoscopic Nerve-Preserving Radical Proctectomy for Rectal Cancer: A Prospective Controlled Trial

“…Rehabilitation programs for these patients are complex. Psychological evaluation and support of the patient and his or her partner are mandatory, resulting in enhancing the response to pharmacologic therapy (Eveno, Lamblin, Mariette, & Pocard, 2010). Among the medications available, the efficacy of sildenafil was demonstrated in a study where 32 patients were randomized to medical treatment or placebo after rectal resection (Lindsey et al, 2002).…”

Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer

“…18,19 Duran et al 20 noted a 17.8% decrease in the sexual function of men compared with the preoperational period after abdominoperineal resection and low anterior resection. Both erection and ejaculation were impaired significantly.…”

Urinary Dysfunction After Surgical Treatment for Rectal Cancer

“…However, surgeons have direct attention to the preservation of the pelvic nerves in the surgical treatment of rectal cancer. Some authors have investigated the mechanisms of neural injury aiming to promote the preservation of the autonomic innervation of the pelvis and to thus reduce the incidence of functional sequelae (6,7,19,22,26,32) . Such mechanisms include the injury of either the inferior hypogastric plexus or the pelvic splanchnic nerves due to violation of the avascular plane between the visceral and parietal pelvic fascia (22,27) .…”

“…Such mechanisms include the injury of either the inferior hypogastric plexus or the pelvic splanchnic nerves due to violation of the avascular plane between the visceral and parietal pelvic fascia (22,27) . Ligation of the inferior mesenteric artery at its origin, close to the aorta, with sectioning of superior hypogastric plexus fibres concomitant or not to sectioning of the inferior hypogastric plexus is another neural injury mechanism that has been investigated (6,7,19,22,27,32) . Studies based on cadaveric surgery showed that dissection along the presacral fascia and injury of the levator ani nerve, which innervates the levator ani muscle, a crucial component of the urinary and faecal continence system, are also causes of sequelae affecting the pelvic floor (32) .…”

“…The concept of total mesorectal excision (TME), which includes anatomical dissection of the pelvic fascia and recognition of vascular and nerve structures, has allowed better outcomes in terms of local recurrence and functional morbidity of the pelvic organs (11,12,15) . The function of the pelvic organs depends on the neural integrity of the pelvic autonomic plexuses; thus, its preservation is one of the priorities in surgery (6,27) . The voluntary control of the lower urinary tract depends on the adequate interaction of the autonomic innervation, mediated by sympathetic and parasympathetic fibres, with the somatic innervation, mediated by the pudendal nerves (7,19) .…”