Bladder and erectile dysfunction before and after rectal surgery for cancer.
OBJECTIVE
To establish the incidence of bladder and erectile dysfunction after rectal surgery for cancer.


METHODS
Twenty patients (16 men and four women, median age 66 years, range 36-78) with carcinoma of the rectum were prospectively studied immediately before and 4 months after operation by clinical assessment, uroflowmetry and video-cystometrography. All patients were catheterized routinely at the time of surgery. Those experiencing voiding difficulties after catheter removal were managed by intermittent self-catheterization or an indwelling urethral catheter.


RESULTS
Before surgery, only six patients had completely normal bladder function and 13 of the 16 men were at least partially potent. Eight of the 19 patients who eventually had surgery developed identifiable bladder dysfunction, of whom three had urodynamic evidence of complete bladder denervation. Three men who were potent before became impotent after surgery.


CONCLUSIONS
Bladder and erectile dysfunction are recognized complications of radical rectal surgery, although there is significant variation in the reported risk; much of this variability is related to the retrospective nature of most previous studies. This study demonstrates the importance of prospective urodynamic evaluation and confirms that the small but significant risk of permanent bladder dysfunction is likely to be related to pelvic nerve injury at the time of surgery.
Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
J
J
Leveckis
N R
NR
Boucher
B T
BT
Parys
M W
MW
Reed
A J
AJ
Shorthouse
J B
JB
Anderson
D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000503:physiopathology; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000503:physiopathology; D016055:Urinary Retention / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics