Intraoperative monitoring of bladder and internal anal sphincter innervation: a predictor of erectile function following low anterior rectal resection for rectal cancer? Results of a prospective clinical study.
BACKGROUND
The objective was to investigate whether two-dimensional intraoperative neuromonitoring (IONM) of pelvic autonomic nerves has the potential to predict erectile function (EF) following surgery for rectal cancer.


METHODS
A consecutive series of 17 sexually active male rectal cancer patients undergoing IONM-based nerve-sparing low anterior rectal resection were evaluated prospectively. IONM was performed by electric stimulation of the pelvic splanchnic nerves with concomitant electromyography of the internal anal sphincter and cystomanometry. Sexual function was assessed using a validated questionnaire.


RESULTS
The degree of agreement between electromyography-based and cystomanometry-based IONM with postoperative EF was moderate and good (κ = 0.43 and κ = 0.66). Combined assessment yielded the best agreement (κ = 0.76) with sensitivity of 90%, specificity of 86%, positive predictive value of 90%, negative predictive value of 86%, and overall accuracy of 88%, respectively, in terms of prediction of postoperative EF.


CONCLUSIONS
The method may be suitable to predict male EF following rectal resection.
Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg University Mainz, Mainz, Germany.
Werner
W
Kneist
Daniel W
DW
Kauff
Peter
P
Rubenwolf
Christian
C
Thomas
Christian
C
Hampel
Hauke
H
Lang
D000368:Aged; D001003:Anal Canal / Q000294:innervation*; D017776:Autonomic Pathways / Q000503:physiopathology*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D007172:Erectile Dysfunction / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D001743:Urinary Bladder / Q000294:innervation*