title: Female urogenital dysfunction following total mesorectal excision for rectal cancer.
abstract: BACKGROUND
  The effect of Total Mesorectal Excision (TME) on sexual function in the male is well documented. However, there is little literature in female patients. The aim of this study was to review the pelvic autonomic nervous anatomy in the female and to perform a retrospective audit of urinary and sexual function in women following surgery for rectal cancer where TME had been performed. Urogenital dysfunction was assessed through interview and questionnaire.
  
  
  METHODS
  Twenty-three questionnaires, eighteen returned, were sent to women with a mean age 65.5 yrs (range 34-86). All had undergone total mesorectal excision for rectal cancer between 1998-2001. Mean follow-up was 18.8 months (range 3-35).
  
  
  RESULTS
  Preoperatively 5/18 (28%) were sexually active, 3/18 (17%) of patients described urinary frequency and nocturia and 7/18 (39%) described symptoms of stress incontinence prior to surgery. Postoperatively all sexually active patients remained active although all described some discomfort with penetration. Two of the patients sexually active described reduced libido secondary to the stoma. Postoperative urinary symptoms developed with 59% reporting the development of nocturia, 18% developed stress incontinence and one patient required a permanent catheter. Of those with symptoms, 80% persisted longer than three months from surgery. Symptoms were predominant in those patients with low rectal cancers, particularly those undergoing abdomino-perineal excision and in those who had previously undergone abdominal hysterectomy.
  
  
  CONCLUSIONS
  The treatment of rectal cancer involves surgery to the pelvic floor. Despite nerve preservation this is associated with the development of worsening nocturia and stress incontinence. This is most marked in those patients who had previously undergone a hysterectomy. Further studies are warranted to assess the interaction with previous gynaecological surgery.
authors.affiliation: Department of Colorectal Surgery, Epsom General Hospital, Dorking Road, Epsom, UK. i.daniels@pelicancancer.org
authors.forename: Ian R
authors.initials: IR
authors.lastname: Daniels
authors.forename: Sheena
authors.initials: S
authors.lastname: Woodward
authors.forename: Fiona G M
authors.initials: FG
authors.lastname: Taylor
authors.forename: Ashraf
authors.initials: A
authors.lastname: Raja
authors.forename: Paul
authors.initials: P
authors.lastname: Toomey