title: Male sexual function after laparoscopic total mesorectal excision.
abstract: OBJECTIVE
  The aim of this prospective study was to clarify the frequency of male sexual dysfunction after laparoscopic total mesorectal excision (LTME) and to examine the relationship between pelvic autonomic nerve (PAN) preservation status and functional outcomes.
  
  
  METHODS
  Candidates for LTME were included in this study. PAN preservation status after LTME was examined in detail by video review. Patients completed a functional questionnaire (the International Index of Erectile Function) before and 3, 6 and 12 months after the operation.
  
  
  RESULTS
  Twenty-six patients who underwent LTME were assessable. Detailed video reviews identified inadvertent PAN damage during surgery. PAN injury was observed in 11 cases (41%), including eight cases (32%) of inadvertent PAN damage (incomplete preservation group). There was a trend toward increasing inadvertent PAN injury rate in patients with high body mass index and large tumours. The results from all patients who underwent LTME showed no deterioration in total International Index of Erectile Function or its domain scores 12 months after surgery. In the incomplete preservation group, these scores temporarily decreased (3 and 6 months after surgery), but such deterioration was not observed in the complete preservation group. Most of the 12 patients with potentially active erectile function before the operation recovered this function, and only one patient (7%) with PAN injury was still judged as inactive 12 months after surgery.
  
  
  CONCLUSIONS
  The proportion of patients with sexual dysfunction after LTME is low. With the enhanced visibility of the laparoscope, inadvertent PAN injury was detected in a significant number of cases and associated with transient deterioration of sexual function.
authors: Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: K
authors: K
authors: Hida
authors: S
authors: S
authors: Hasegawa
authors: Y
authors: Y
authors: Kataoka
authors: S
authors: S
authors: Nagayama
authors: K
authors: K
authors: Yoshimura
authors: A
authors: A
authors: Nomura
authors: K
authors: K
authors: Kawada
authors: J
authors: J
authors: Kawamura
authors: Y
authors: Y
authors: Kinjo
authors: Y
authors: Y
authors: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001341:Autonomic Nervous System / Q000503:physiopathology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D007172:Erectile Dysfunction / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000294:innervation* / Q000473:pathology; D059348:Peripheral Nerve Injuries / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D011795:Surveys and Questionnaires; D014741:Video Recording