title: Risk Factor Analysis for Newly Developed Urogenital Dysfunction after Total Mesorectal Excision and Impact of Pelvic Intraoperative Neuromonitoring-a Prospective 2-Year Follow-Up Study.
abstract: Urogenital dysfunction is a common sequela following total mesorectal excision for rectal cancer. This prospective study analyzed potential risk factors and investigated the impact of pelvic intraoperative neuromonitoring.
  
  
  
  Included were 85 patients undergoing total mesorectal excision for rectal cancer, 43 under the control of pelvic intraoperative neuromonitoring. Urogenital function was assessed with validated questionnaires within a 2-year follow-up period. Potential risk factors were identified by multivariate analysis.
  
  
  
  Overall, approximately one-third of treated patients suffered from new onset of urinary dysfunction. Initially, half of the sexually active patients were affected by sexual dysfunction; after 2 years, almost three quarters were affected. In the pelvic intraoperative neuromonitoring group, urinary and sexual dysfunction rates including minor and major disturbances were significantly lower (2-year follow-up 20% vs. 51% (p = 0.004) and 56% vs. 90% (p = 0.010)). Throughout the survey, non-performance of pelvic intraoperative neuromonitoring was found to be an independent risk factor. Neoadjuvant chemoradiotherapy was identified as an independent predictor for urogenital dysfunction in the further course one and 2 years after surgery.
  
  
  
  Pelvic intraoperative neuromonitoring is associated with significantly lower rates of urinary and sexual dysfunction in the short and long run, whereas neoadjuvant chemoradiotherapy has a negative impact only in the long run.
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. daniel.kauff@unimedizin-mainz.de.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Kauff
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Kneist
mesh_terms: D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D059351:Organ Sparing Treatments; D010388:Pelvis / Q000294:innervation*; D059348:Peripheral Nerve Injuries / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Autonomic nervous system; Intraoperative monitoring; Neoadjuvant therapy; Rectal cancer; Urogenital dysfunction