Genito-urinary sequelae after carcinological rectal resection: What to tell patients in 2017.
Although we have seen revolutionary changes with multi-disciplinary management of patients with rectal cancer, the evaluation of genito-urinary sequelae remains of great concern. Precise pre-operative evaluation with validated scores allows detection of urinary disorders in 16 to 23% of patients, and sexual disorders in nearly 35% of men and 50% of women. Regardless of the surgical approach, it is fundamental to respect the autonomic innervation during total mesorectal excision in order to prevent these sequelae. Identification of these nerves can be facilitated by intra-operative neuro-stimulation. In spite of these precautions, de novo urinary sequelae are observed in nearly 33% of patients and bladder evacuation disorders in 25% of patients. Advanced age, pre-operative urinary disorders, female gender, and abdomino-perineal resection are independent risk factors for urinary sequelae. Early post-operative urodynamic abnormalities might be predictive of these sequelae and justify early physiotherapy. Likewise, sexual sequelae such as erectile and/or ejaculatory disorders, dyspareunia and lubrication deficits result in de novo cessation of sexual activity in 28% of men and 18% of women. Advanced age, neo-adjuvant radiation therapy, and abdomino-perineal resection are independent risk factors for sexual dysfunction. Pharmacotherapy with sildenafil has proven useful in the treatment of erectile disorders. Genito-urinary and ano-rectal sequelae occur concomitantly in more than one of ten patients, suggesting a potential common pathophysiology.
Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France.
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Abdelli
Service d'urologie et de transplantation rénale, CHU de Caen, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France.
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Tillou
Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France.
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Alves
Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France. Electronic address: menahem-b@chu-caen.fr.
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Menahem
D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D052801:Male Urogenital Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000294:innervation / Q000601:surgery*
Carcinological proctectomy; Radiation therapy; Sexual sequelae; Urinary sequelae