title: Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer.
abstract: BACKGROUND
  Urinary and sexual dysfunctions are recognized complications of rectal cancer surgery. Their incidence after robotic surgery is as yet unknown. The aim of this study was to prospectively evaluate the impact of robotic surgery for rectal cancer on sexual and urinary functions in male and female patients.
  
  
  METHODS
  From April 2008 to December 2010, 74 patients undergoing fully robotic resection for rectal cancer were prospectively included in the study. Urinary and sexual dysfunctions affecting quality of life were assessed with specific self-administered questionnaires in all patients undergoing robotic total mesorectal excision (RTME). Results were calculated with validated scoring systems and statistically analyzed.
  
  
  RESULTS
  The analyses of the questionnaires completed by the 74 patients who underwent RTME showed that sexual function and general sexual satisfaction decreased significantly 1 month after intervention: 19.1 ± 8.7 versus 11.9 ± 10.2 (P < 0.05) for erectile function and 6.9 ± 2.4 versus 5.3 ± 2.5 (P < 0.05) for general satisfaction in men; 2.6 ± 3.3 versus 0.8 ± 1.4 (P < 0.05) and 2.4 ± 2.5 versus 0.7 ± 1.6 (P < 0.05) for arousal and general satisfaction, respectively, in women. Subsequently, both parameters increased progressively, and 1 year after surgery, the values were comparable to those measured before surgery. Concerning urinary function, the grade of incontinence measured 1 year after the intervention was unchanged for both sexes.
  
  
  CONCLUSIONS
  RTME allows for preservation of urinary and sexual functions. This is probably due to the superior movements of the wristed instruments that facilitate fine dissection, coupled with a stable and magnified view that helps in recognizing the inferior hypogastric plexus.
authors.affiliation: Division of Abdomino-Pelvic Surgery, European Institute of Oncology, Milano, Italy. fabrizio.luca@ieo.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Luca
authors.forename: Manuela
authors.initials: M
authors.lastname: Valvo
authors.forename: Tiago Leal
authors.initials: TL
authors.lastname: Ghezzi
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Zuccaro
authors.forename: Sabina
authors.initials: S
authors.lastname: Cenciarelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Trovato
authors.forename: Angelica
authors.initials: A
authors.lastname: Sonzogni
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012371:Robotics; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000209:etiology*