Rectal mucosal prolapse in males: surgery is effective for fecal incontinence but not for obstructed defecation.
BACKGROUND
The aim of this prospective study was to evaluate the functional outcome of transanal surgery in male patients suffering from fecal incontinence, soiling, and obstructed defecation associated with rectal mucosal prolapse.


METHODS
All male patients who underwent transanal surgery (either stapled or Delorme mucosectomy) for rectal mucosal prolapse associated with fecal incontinence and obstructed defecation were prospectively enrolled in the study. The recruitment phase was 17 months (April 2011 to August 2012). Symptom evaluation was based on the validated scores preoperatively and 12 months after surgery (Wexner incontinence score and Wexner constipation score). The primary end point was "success," which was defined as a 50 % reduction in symptoms. Using a decision-tree algorithm, patient groups with the highest and lowest chance of success were identified.


RESULTS
Thirty-eight male patients (mean age 51 years) underwent transanal surgery for rectal mucosal prolapse. The predominant symptoms were fecal incontinence in 31 patients (82 %) and obstructed defecation in 7 (18 %). Stapled mucosectomy was performed in 34 patients and Delorme mucosectomy in 4 patients. No major morbidity occurred. Symptom resolution for soiling was 77 %, itching and mucus secretion were improved in 47 and 50 %, and bleeding resolved in 89 % of patients affected. Functional outcome was good in 90 % (28/31) of the patients with fecal incontinence but in only 28 % (2/7) for obstructed defecation. The Wexner incontinence score decreased significantly (11.1 vs. 3.9, p < 0.01), whereas the Wexner constipation score was not influenced (18.4 vs. 15.6, p > 0.05). Using a decision-tree algorithm, a success rate of 96 % was observed in patients with fecal incontinence associated with younger age (age <45 years) and no presence of fecal urgency prior to surgery.


CONCLUSIONS
Transanal stapled mucosectomy for rectal mucosal prolapse in males is effective for fecal incontinence, but not for obstructed defecation.
Department of Proctology, Krankenhaus Barmherzige Brueder Regensburg, Pruefeninger Str. 89, 93049, Regensburg, Germany, oliver.schwandner@barmherzige-regensburg.de.
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Schwandner
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Schrinner
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D003248:Constipation / Q000601:surgery; D003672:Defecation; D004688:Encopresis / Q000601:surgery; D005242:Fecal Incontinence / Q000150:complications / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000150:complications* / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D017792:Surgical Stapling / Q000009:adverse effects; D016896:Treatment Outcome