title: Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer.
abstract: BACKGROUND
  Bladder and sexual dysfunction are well-documented complications of rectal cancer surgery. This study aimed to determine whether laparoscopy can improve the outcome of these dysfunctions or not.
  
  
  METHODS
  The study included 63 of the 116 patients who underwent surgery for rectal cancer between 2002 and 2006. Bladder and male sexual function were studied by means of a questionnaire on the basis of the International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF). In addition, bladder function was determined by means of postvoid residual urine measurement and uroflowmetry. Postoperative functions were compared with the preoperative data to detect subjective functional deterioration. Outcomes were compared between patients who underwent open (group 1, n = 29) and laparoscopic (group 2, n = 34) total mesorectal excision.
  
  
  RESULTS
  Only minor disturbances of bladder function were reported for one patient (3%) in group 1 and three patients (9%) in group 2 (p > 0.05). Impotency after surgery was experienced by 6 of 17 preoperatively sexually active males (29%) in group 1 and 1 of 18 males (5%) in group 2 (p = 0.04). Similarly, 5 of 10 women (50 %) in group 1 and 1 of 14 women (7%) in group 2 felt that their overall level of sexual function had decreased as a result of surgery (p = 0.03).
  
  
  CONCLUSIONS
  Open rectal cancer resection is associated with a higher rate of sexual dysfunction, but not bladder dysfunction, compared with laparoscopic surgery. Laparoscopic rectal cancer surgery offers a significant advantage with regard to preservation of postoperative sexual function and constitutes a true advance in rectal cancer surgery compared with the open technique. The proposed advantages can be attributed to improvement in visibility by the magnification feature of laparoscopic surgery.
authors.affiliation: Department of Surgery, Istanbul Medical School, Istanbul University, Akyildiz sitesi, Birlik sokak, B Blok, 1 Levent, Istanbul, Turkey. oktarasoglu@yahoo.com
authors.forename: Oktar
authors.initials: O
authors.lastname: Asoglu
authors.forename: Tugba
authors.initials: T
authors.lastname: Matlim
authors.forename: Hasan
authors.initials: H
authors.lastname: Karanlik
authors.forename: Murat
authors.initials: M
authors.lastname: Atar
authors.forename: Mahmut
authors.initials: M
authors.lastname: Muslumanoglu
authors.forename: Yersu
authors.initials: Y
authors.lastname: Kapran
authors.forename: Abdullah
authors.initials: A
authors.lastname: Igci
authors.forename: Vahit
authors.initials: V
authors.lastname: Ozmen
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kecer
authors.forename: Mesut
authors.initials: M
authors.lastname: Parlak
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D014555:Urination Disorders / Q000453:epidemiology*; D014563:Urodynamics