Validity of pelvic autonomic nerve stimulation with intraoperative monitoring of bladder function following total mesorectal excision for rectal cancer.
OBJECTIVE
This prospective study was designed to clarify whether the results of the intraoperative stimulation of parasympathetic pelvic nerves performed in 31 patients after mesorectal excision for rectal carcinoma allowed predictions in terms of the postoperative bladder function of the patients.


METHODS
After monopolar stimulation of the splanchnic pelvic nerves using a constant voltage stimulator (Screener 3625), intravesical pressure increase was measured manometrically. The results were related to the postoperative residual urine volume, requirement of recatheterization and long-term catheterization, just as to the results of the validated International Prostatic Symptom Scores and the Quality of Life Index caused by urinary symptoms. The median follow-up period was nine (range, 2-14) months.


RESULTS
Parasympathetic nerve stimulation was performed at 61 sites and results in intravesical pressure increase up to 6 cm water column in median. In 11 patients (33.3 percent), a negative test result was achieved: 5 with unilateral and 6 with bilateral pressure increases of < or = 2 cm water column. Recatheterization was necessary in four patients, and all of them showed negative neuromonitoring results. Two of these patients were discharged with an in situ urinary bladder catheter. Postoperative increased residual urine volumes (> or =100 ml) resulted more frequently in the group with negative test results (63.6 vs. 21.1 percent; P = 0.047), and the International Prostatic Symptom Score and Quality of Life Index showed the worst results (9.9 +/- 6.7 vs. 3 +/- 4.9, P = 0.021; 2.4 +/- 1.7 vs. 0.7 +/- 1.3, P = 0.021).


CONCLUSIONS
Intraoperative neurostimulation and manometric measurement of bladder pressure may contribute to the identification of parasympathetic pelvic nerves during total mesorectal excision. This method is suitable for intraoperative recording of nerve preservation and therefore associated with postoperative bladder function.
Kneist
W
W
Clinic of General and Abdominal Surgery, Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany. kneist@ach.klinik.uni-mainz.de
Junginger
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010275:Parasympathetic Nervous System / Q000033:anatomy & histology / Q000503:physiopathology*; D010388:Pelvis / Q000294:innervation*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D018709:Statistics, Nonparametric; D001743:Urinary Bladder / Q000294:innervation* / Q000503:physiopathology*; D001750:Urinary Bladder, Neurogenic / Q000517:prevention & control