Sexual and urinary dysfunction following laparoscopic total mesorectal excision in male patients: A prospective study

Abstract

Aims:Even with the use of nerve-sparing techniques, there is a risk of bladder and sexual dysfunction after total mesorectal excision (TME). Laparoscopic TME is believed to improve this autonomic nerve dysfunction, but this is not demonstrated conclusively in the literature. In Indian patients generally, the stage at which the patients present is late and presumably the risk of autonomic nerve injury is more; however, there is no published data in this respect.Materials and Methods:This prospective study in male patients who underwent laparoscopic TME evaluated the bladder and sexual dysfunction using objective standardised scores, measuring residual urine and post-voided volume. The International Prostatic Symptom Score (IPSS) and International Index of Erectile Function score were used respectively to assess the bladder and sexual dysfunction preoperatively at 1, 3, 6 months and at 1 year.Results:Mean age of the study group was 58 years. After laparoscopic TME in male patients, the moderate to severe bladder dysfunction (IPSS <8) is observed in 20.4% of patients at 3 months, and at mean follow-up of 9.2 months, it was seen only in 2.9%. There is more bladder and sexual dysfunction in low rectal tumours compared to mid-rectal tumours. At 3 months, 75% had sexual dysfunction, 55% at median follow-up of the group at 9.2 months.Conclusion:After laparoscopic TME, bladder dysfunction is seen in one-fifth of the patients, which recovers in the next 6 months to 1 year. Sexual dysfunction is observed in 75% of patients immediately after TME which improves to 55% over 9.2 months.

The erectile and ejaculatory implications of the surgical management of rectal cancer

“…[24][25][26] Men may be able to regain sexual function over time, as the incidence of sexual dysfunction decreased from 75% (3 months postoperatively) to 55% (9 months postoperatively). 27 Similar data were seen in a prospective study comparing erectile and ejaculatory function 3 months versus 1 year following surgery. 28 More data are needed to elucidate the mechanistic causes of the improvements in sexual parameters over time.…”

“…The incidence of sexual dysfunction post‐LAR can vary from 32% to 69% 24–26 . Men may be able to regain sexual function over time, as the incidence of sexual dysfunction decreased from 75% (3 months postoperatively) to 55% (9 months postoperatively) 27 . Similar data were seen in a prospective study comparing erectile and ejaculatory function 3 months versus 1 year following surgery 28 .…”

“…• Generally better b a While multiple studies on patients after APR for rectal cancer have shown higher local recurrence rates than after LAR, 4,26,27 other studies have found no difference. 28,29 b Quality of life metrics in patients after undergoing LAR for rectal cancer have largely been shown to be superior to those noted in patients after undergoing APR.…”

“… a While multiple studies on patients after APR for rectal cancer have shown higher local recurrence rates than after LAR, 4,26,27 other studies have found no difference 28,29 …”

PDE-5i Management of Erectile Dysfunction After Rectal Surgery: A Systematic Review Focusing on Treatment Efficacy

“…In case of oncologic surgery, tumor stage, tumor invasion, and administration of neoadjuvant and adjuvant chemoradiation therapies have been reported to increase the risk of ED (Bonnel et al, 2002; Giglia & Stein, 2019; Huang et al, 2016; Lange et al, 2009). Conversely, surgical rectal resections performed for benign pathologies, like inflammatory bowel disease (IBD), appear to be associated with a lower incidence of ED, but the risk is not completely eradicated even when nerve-sparing techniques are applied (Celentano, 2017; George et al, 2018).…”