The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer.
BACKGROUND
The aim of the present study is to symptomatically analyze the extent to which pelvic nerve-sparing radical surgery for rectal cancer impacts on long-term voiding and male sexual function.


METHODS
A self-administered questionnaire was mailed to 68 patients who underwent pelvic nerve-sparing radical surgery for invasive rectal cancer with 52 responses (28 men and 24 women; 27 complete and 25 incomplete preservation; response rate 76.5%). Each patient was asked to record if there had been any changes in lower urinary tract symptoms after surgery. Sexual function was also investigated in men.


RESULTS
Of the 52 patients, 48 (92%) maintained voluntary voiding without catheterization in the long term. Clean intermittent self-catheterization was performed in only four patients with incomplete preservation because of persistent voiding dysfunction. Subjectively, approximately 60% of the patients remained unchanged in lower urinary tract symptoms after surgery. The satisfaction rate regarding the current voiding status was significantly higher in women than in men (83% versus 61%, P = 0.0294), but was not significantly different between those with complete (76%) and incomplete preservation (64%). Despite the acceptable urinary status, 88% of men had some deterioration in the erectile function, regardless of the types of surgical procedures. Overall, 64% of men were unsatisfied with the current sexual function.


CONCLUSIONS
Pelvic nerve-sparing radical surgery for rectal cancer preserved the long-term voiding function in the majority of patients. In completely preserved patients and in women, symptomatic outcomes were more satisfactory. Postoperative erectile dysfunction was found to be a serious problem, even in complete nerve-sparing procedure.
Ameda
Kaname
K
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. KanameAmeda@aol.com
Kakizaki
Hidehiro
H
Koyanagi
Tomohiko
T
Hirakawa
Kazushi
K
Kusumi
Takaya
T
Hosokawa
Masao
M
D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012737:Sex Factors; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology*; D014566:Urogenital System / Q000294:innervation