title: Sexual and urinary dysfunction following rectal dissection compared with segmental colectomy.
abstract: BACKGROUND
  The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy.
  
  
  METHODS
  Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C).
  
  
  RESULTS
  More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream--13%vs 38%, P = 0.001 and 21%vs 21%, P = NS; incontinence--4.2%vs 17%, P = 0.008 and 8%vs 8%, P = NS; hesitancy--13%vs 35%, P = 0.034 and 17%vs 21%, P = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men--62.5%, women--25%vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision--50%vs segmental colectomy - 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy. Conclusion More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorial.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. tam-per@hotmail.com
authors.forename: M T P R
authors.initials: MT
authors.lastname: Perera
authors.forename: K I
authors.initials: KI
authors.lastname: Deen
authors.forename: S R E
authors.initials: SR
authors.lastname: Wijesuriya
authors.forename: S K
authors.initials: SK
authors.lastname: Kumarage
authors.forename: S T U
authors.initials: ST
authors.lastname: De Zylva
authors.forename: M H J
authors.initials: MH
authors.lastname: Ariyaratne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004414:Dyspareunia / Q000209:etiology*; D007172:Erectile Dysfunction / Q000209:etiology*; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009948:Orgasm / Q000502:physiology; D012007:Rectum / Q000601:surgery*; D014555:Urination Disorders / Q000209:etiology*; D055815:Young Adult