Avoiding long-term disturbance to bladder and sexual function in pelvic surgery, particularly with rectal cancer.
Urinary and sexual dysfunction are common problems after rectal cancer surgery, and the likely cause is damage to the pelvic autonomic nerves during surgery. In recent years, attention has been focused on preserving the autonomic nerves through a technique which is usually combined with total mesorectal excision or radical pelvic lymphadenectomy. The autonomic nerves consist of the paired sympathetic hypogastric nerve, sacral splanchnic nerves, and the pelvic autonomic nerve plexus. We will demonstrate the anatomy of the pelvic autonomic nerves and the relation of these nerves to the mesorectal fascial planes, and review the medical literature on sexual and urinary dysfunction after rectal cancer surgery with and without autonomic nerve preservation.
Havenga
K
K
Department of Surgery, Nijmegen University Medical Center, The Netherlands. havenga@telekabel2.nl
Maas
C P
CP
DeRuiter
M C
MC
Welvaart
K
K
Trimbos
J B
JB
D001341:Autonomic Nervous System / Q000293:injuries; D007172:Erectile Dysfunction / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000293:injuries*; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D010388:Pelvis / Q000294:innervation*; D011183:Postoperative Complications / Q000517:prevention & control; D012004:Rectal Neoplasms / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000517:prevention & control*; D014555:Urination Disorders / Q000517:prevention & control*