Amarillo HA, Fernández PA, Guerrero M, Manson RR, Amarillo HR

Language: Spanish
References: 13
Page: 63-68
PDF size: 104.11 Kb.

ABSTRACT

Background: Secondary lesion of pelvic autonomic plexus after total mesorectal excision develops bladder and sexual dysfunction. It may affect quality of life particularly in young patients after rectal cancer surgery. Objective: To analyze incidence of genital and bladder dysfunction in patients with total mesorectal excision and to evaluate associated factors. Design: Retrospective. Period: 2005-2006. Material: Male patients with total mesorectal excision for rectal cancer. Exclusion: Female, superior rectal cancer, palliative surgery, previous dysfunction. Methods: Age, type of surgery, postoperative morbidity and mortality, postoperative and preoperatory dysfunction and treatment were evaluated. Statistical analysis included Mann-Whitney, Wilcoxon, t-Student and Fisher Tests (p ‹ 0.05). Simple questionary and clinical evaluation were performed in all cases. Results: 45 male patients with rectal cancer and total mesorectal excision were analyzed (28 female and 1 previous dysfunction were excluded). All were elective surgeries (2 Miles and 16 anterior rectal resection). Preoperative radiotherapy were used in 15 patients. Four cases of postoperative dysfunction occurred (3 retrograde ejaculation, 1 erectile). Results showed two groups: the group with dysfunction were 4, average age was 48 and Miles surgery in 2, all were treated with long preoperative radiotherapic courses, and they all presented postoperative morbidity. The second group without postoperative dysfunction were 14 cases, average age was 58 and morbidity only happened in 2 cases, and the mostly had preoperative radiotherapy. Statistical significance were found comparatively in age and type of surgery between these groups. Conclusions: Associated factors to postoperative genital and bladder dysfunction included age below 50 years, postoperative morbidity, preoperative radiotherapy and Miles surgery.

REFERENCES

1. Heald R. The holy plane of rectal surgery. J R Soc Med 1988; 81: 503-508.

2. Heald R, Moran B, Ryall R, Sexton R, MacFarlane J. The basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg 1998; 133: 894-899.

3. Heald R, Smedh R, Kald A, Sexton R, Moran B. Abdominoperineal excision of the rectum – an endangered operation. Dis Colon Rectum 1997; 30: 747-751.

4. Karanija N, Corder A, Bearn P, Heald R. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994; 81: 1224-1226.

5. Izanec J, Nagle D. Impact of proctectomy on continence and sexual function in women. Amer J Gastroent 2006; 101: s3, s618-s624.

6. Gosselink M, Busschbach J, Dijkhuis C, Stassen L, Hop W, Schouten W. Quality of life after total mesorectal excision for rectal cancer. Colorectal Disease 2006; 8: 1, 15-22.

7. Kneist W, Junginger T. Residual urine volume after total mesorectal excision: an indicator of pelvic autonomic nerve preservation? Result of a case-control study. Colorectal Disease 2004; 6: 432-437.

8. Del Rio C, Sanchez Santos R, Oreja V, Oca J, Biondo S, Pares D, Osorio J. Long term urinary dysfunction after total rectal cancer surgery. Colorectal Disease 2004; 6: 3, 198-202.

9. Quah H, Jayne D, Seow Choen F. Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 2002; 89: 1551-1556.

10. Nesbakken A, Nygaard N, Lunde O. Mesorectal excision for rectal cancer: functional outcome after low anterior resection and colorectal anastomosis without reservoir. Colorectal Disease 2002; 4: 172-176.

11. Maurer C, Graggen K, Renzulli P, Schilling K, Netzer P, Buchler M. Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery. Br J Surg 2001; 88: 1501-1505.

12. Shah E, Huddy P. A prospective study of genitourinary dysfunction after surgery for colorectal cancer. Colorectal Disease 2001; 3: 122-125.

13. Nesbakken, Nygaard K, Bull T, Carlsen E, Eri L. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 2000; 87: 206-210.