Voiding and Sexual Dysfunction following Total Mesorectal Excision and Autonomic Nerve Preservation for Rectal Cancer in Males: A Prospective Study

Han Young Choi; Kwanjin Park; Dae-yong Hwang; Sun-Mi Moon

doi:10.4111/kju.2008.49.11.1041

Journal List > Korean J Urol > v.49(11) > 1005024

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Park, Hwang, and Moon: Voiding and Sexual Dysfunction following Total Mesorectal Excision and Autonomic Nerve Preservation for Rectal Cancer in Males: A Prospective Study

Original Article

Korean J Urol 2008;49(11):1041-1045.

Published online: 20 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.11.1041

Voiding and Sexual Dysfunction following Total Mesorectal Excision and Autonomic Nerve Preservation for Rectal Cancer in Males: A Prospective Study

Han Young Choi, Kwanjin Park, Dae-yong Hwang¹, Sun-Mi Moon¹

From the Department of Urology, Seoul, Korea

¹Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea

Received 7 July 2008 Revised 28 July 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We designed a prospective study to evaluate the effects of total mesorectal excision and autonomic nerve preservation (TME-ANP) on postoperative genitourinary function in the course of time and the quantitative effects of various peri-operative risk factors on the postoperative genitourinary dysfunction.

Materials and Methods

Forty-five patients who underwent TME-ANP with rectal cancer were prospectively examined before and after operation, as well after the first, third and sixth postoperative month. The preoperative urological evaluation consisted of International Prostate Symptom Score (IPSS), Erectile Function Domain score in International Index of Erectile Function (IIEF-EFD), Ejaculation domain in Male Sexual Health Questionnaire (MSHQ-EjD) and urodynamic study.

Results

Preoperative IPSS decreased significantly in postoperative 1 month. But there was no difference between preoperative IPSS and postoperative IPSS after 3 month of operation. Erectile function significantly decreased in the course of time (p-trend＜0.05). Ejaculation function also significantly decreased after 1 month of operation, however no significant change of MSHQ-EjD was observed thereafter. Multivariate analysis revealed history of abdominoperineal resection and baseline mild erectile dysfunction were found to be the risk factors of decreasing erectile function. Diabetes was associated with diminishing ejaculatory function.

Conclusions

While the voiding dysfuncion was no longer problematic following TME-ANP, substantial number of sexual dysfunction persisted despite TME-ANP.

Keywords: Rectal cancer, Total mesorectal excision, Pelvic autonomic preservation, Voiding function, Sexual function

References

1. Paick JS, Oh SJ, Park JG, Choe KJ, Kim SH. Change in potency following rectal cancer surgery. Korean J Urol. 1994; 35:655–64.

2. Lee SE, Oh SJ, Lee MS, Seo JM, Park JG, Choi KJ, et al. Voiding dysfunction after rectal cancer surgery: analysis by symptom score and residual urine volume. Korean J Urol. 1994; 35:156–64.

3. Oh SJ, Park JG, Choe KJ, Lee SE. Bladder dysfunction after rectal cancer surgery: urodynamic evaluation. Korean J Urol. 1993; 34:689–704.

4. Havenga K, Maas CP, DeRuiter MC, Welvaart K, Trimbos JB. Avoiding longterm disturbance to bladder and sexual dysfunction in pelvic surgery, particularly with rectal cancer. Semin Surg Oncol. 2000; 18:235–43.

5. Leveckis J, Boucher NR, Parys BT, Reed MW, Shorthouse AJ, Anderson JB. Bladder and erectile dysfunction before and after rectal surgery for cancer. Br J Urol. 1995; 76:752–6.

6. Vironen JH, Kairaluoma M, Aalto AM, Kellokumpu IH. Impact of functional results on quality of life after rectal cancer surgery. Dis Colon Rectum. 2006; 49:568–78.

7. Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Holzel D. Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg. 2003; 238:203–13.

8. Camilleri-Brennan J, Steele RJ. Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer. Br J Surg. 2001; 88:1617–22.

9. Heald RJ. Total mesorectal excision is optimal surgery for rectal cancer: a Scandinavian consensus. Br J Surg. 1995; 82:1297–9.

10. Heald RJ. The holy plane of rectal surgery. J R Soc Med. 1988; 81:503–8.

11. Sugihara K, Moriya Y, Akasu T, Fujita S. Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer. 1996; 78:1871–80.

12. Mundy AR. An anatomical explanation for bladder dysfunction following rectal and uterine surgery. Br J Urol. 1982; 54:501–4.

13. Zinreich ES, Derogatis LR, Herpst J, Auvil G, Piantadosi S, Order SE. Pre and posttreatment evaluation of sexual function in patients with adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1990; 19:729–32.

14. Kim NK. Anatomic basis of sharp pelvic dissection for curative resection of rectal cancer. Yonsei Med J. 2005; 46:737–49.

15. Nesbakken A, Nygaard K, Bull-Njaa T, Carlsen E, Eri LM. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg. 2000; 87:206–10.

16. Havenga K, Enker WE, McDermott C, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg. 1996; 182:495–502.

17. Masui H, Ike H, Yamaguchi S, Oki S, Shimada H. Male sexual function after autonomic nerve-preserving operation for rectal cancer. Dis Colon Rectum. 1996; 39:1140–5.

18. Kim NK, Aahn TW, Park JK, Lee KY, Lee WH, Sohn SK, et al. Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer. Dis Colon Rectum. 2002; 45:1178–85.

19. Sterk P, Shekarriz B, Gunter S, Nolde J, Keller R, Bruch HP, et al. Voiding and sexual dysfunction after deep rectal resection and total mesorectal excision: prospective study on 52 patients. Int J Colorectal Dis. 2005; 20:423–7.

20. Moreland RB. Is there a role of hypoxemia in penile fibrosis; a viewpoint presented to the Society for the Study of Impotence. Int J Impot Res. 1998; 10:113–20.

21. Bahnson RR, Catalona WJ. Papaverine testing of impotent patients following nerve-sparing radical prostatectomy. J Urol. 1988; 139:773–4.

22. Jannini EA, Screponi E, Carosa E, Pepe M, Lo Giudice F, Trimarchi F, et al. Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone. Int J Androl. 1999; 22:385–92.

23. Schmidt CE, Bestmann B, Kuchler T, Kremer B. Factors influencing sexual function in patients with rectal cancer. Int J Impot Res. 2005; 17:231–8.

24. Rabbani F, Stapleton AM, Kattan MW, Wheeler TM, Scardino PT. Factors predicting recovery of erections after radical prostatectomy. J Urol. 2000; 164:1929–34.

Fig. 1.

Study design. UDS: urodynamic study, TRUS: transrectal ultrasonography.

Fig. 2.

International Prostate Symptom Score (IPSS) change before and after rectal cancer operation. ∗: p＜0.05 compared to preoperation.

Fig. 3.

Erectile Function Domain score in International Index of Erectile Function (IIEF-EFD) and Ejaculation score in Male Sexual Health Questionnaire (MSHQ-EjD) changes of before and after rectal cancer operation. ∗: p＜0.05 compared to preoperation, ^†: significant decline of IIEF-EFD in the course of time.

Table 1.

Demographics and past histories (n=45)

Mean age (years)		60.1 (41–78)
Mean BMI (kg/m²)		23.3 (18–30)
Smoking
	Current smoker	11
	Ex-smoker	9
	Non smoker	25
Past history
	Diabetes	14
	Hypertension	17
Stage (UICC)
	1	15
	2	11
	3	15
	4	4

BMI: body mass index, UICC: Union International Contre le Cancer

Table 2.

Perioperative variables (n=45)

Type of surgery
Abdominoperineal resection	11
Low anterior resection	34
Perioperative radiation	26
Preoperative IPSS
Normal (0–7)	11
Mild (8–19)	22
Severe (20–35)	12
Prostate volume (＞40cc)	8
Bladder outlet obstruction	22
Preoperative IIEF-EFD
Normal (26–30)	10
Mild to moderate (17–25)	22
Moderate to severe (6–16)	13
Perceived preoperative ejaculatory dysfunction	6

IPSS: International Prostate Symptom Score, IIEF-EFD: Erectile Function Domain score in International Index of Erectile Function

Table 3.

Risk factors of erectile dysfunction (logistic regression)

Variables	Odds ratio	Confidence interval
Stage 3, 4	2.7	0.88–6.15
Abdominoperineal resection	4.3	2.22–12.15
Age≥65	1.7	0.75–3.66
Smoking	1.1	0.88–1.47
Hypertension	1.7	0.72–4.21
Diabetes mellitus	2.1	0.92–5.54
Mild to moderate preoperative erectile dysfunction	1.9	1.22–5.35

Table 4.

Risk factors of ejaculatory dysfunction (logistic regres sion)

Variables	Odds ratio	Confidence interval
Age≥65	2.3	0.93–4.60
Smoking	1.2	0.68–2.22
Hypertension	1.5	0.79–2.84
Diabetes mellitus	2.1	1.04–6.23
Abdominoperineal resection	3.5	1.58–9.63
Stage 3, 4	3.3	0.84–8.45
Perceived preoperative ejaculatory dysfunction	1.9	0.66–6.48

TOOLS

Similar articles