Pudendal nerve terminal motor latency influences surgical outcome in treatment of rectal prolapse.
OBJECTIVE
This study was undertaken to document the effect of pudendal nerve function on anal incontinence after repair of rectal prolapse.


METHODS
Patients with full rectal prolapse (n = 24) were prospectively evaluated by anal manometry and pudendal nerve terminal motor latency (PNTML) before and after surgical correction of rectal prolapse (low anterior resection (LAR; n = 13) and retrorectal sacral fixation (RSF; n = 11)).


RESULTS
Prolapse was corrected in all patients; there were no recurrences during a mean 25-month follow-up. Postoperative PNTML was prolonged bilaterally (> 2.2 ms) in six patients (3 LAR; 3 RSF); five patients were incontinent (83 percent). PNTML was prolonged unilaterally in eight patients (4 LAR; 4 RSF); three patients were incontinent (38 percent). PNTML was normal in five patients (3 LAR; 2 RSF); one was incontinent (20 percent). Postoperative squeeze pressures were significantly higher for patients with normal PNTML than for those with bilateral abnormal PNTML (145 vs. 66.5 mmHg; P = 0.0151). Patients with unilateral abnormal PNTML had higher postoperative squeeze pressures than those with bilateral abnormal PNTML, but the difference was not significant (94.8 vs. 66.5 mmHg; P = 0.3182). The surgical procedure did not affect postoperative sphincter function or PNTML.


CONCLUSIONS
Injury to the pudendal nerve contributes to postoperative incontinence after repair of rectal prolapse. Status of anal continence after surgical correction of rectal prolapse can be predicted by postoperative measurement of PNTML.
Birnbaum
E H
EH
Washington University School of Medicine, St. Louis, Missouri, USA.
Stamm
L
L
Rafferty
J F
JF
Fry
R D
RD
Kodner
I J
IJ
Fleshman
J W
JW
D000328:Adult; D000368:Aged; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D012007:Rectum / Q000294:innervation*; D016896:Treatment Outcome