Disturbed Colonic Motility Contributes to Anorectal Symptoms and Dysfunction After Radiotherapy for Carcinoma of the Prostate

Yeoh, Eric; Bartholomeusz, Dylan; Holloway, Richard H.; Fraser, Robert; Botten, Rochelle J.; Matteo, Addolorata Di; Moore, James W.; Schoeman, Mark

doi:10.1016/j.ijrobp.2009.08.050

Cited by 19 publications

(15 citation statements)

References 25 publications

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“…Above a certain threshold, rectal intraluminal pressure initiates the urge to defecate. The threshold for urge appears to be variable and may be influenced by acquired changes of the rectal wall (caused for example by inflammatory diseases, radiation, or acquired degenerative changes) [20–23]. …”

Section: Discussionmentioning

confidence: 99%

Rectal prolapse traumatizes rectal neuromuscular microstructure explaining persistent rectal dysfunction

Kraemer¹,

Paulus

Kara³

et al. 2016

Int J Colorectal Dis

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PurposeInternal rectal prolapse is common and correlates with age. It causes a plug-like physical obstruction and is a major cause of defecation disorder. The progressive distortion of the prolapsing rectum likely causes secondary defects in the rectal wall, which may exacerbate rectal dysfunction. We undertook a prospective observational study to detect and quantify the neurologic and histopathologic changes in the rectal wall.MethodsWe examined dorsal and ventral rectal wall specimens from consecutive patients with internal rectal prolapse undergoing stapled transanal rectal resection (STARR). We subjected specimens to histopathologic and neuropathologic assessment, including immunohistochemistry. We also recorded patients’ clinical and demographic characteristics and sought correlations between these and the pathologic findings.ResultsWe examined 100 specimens. The severity of rectal prolapse and the extent of descent of the perineum correlated significantly with age. Concomitant hemorrhoidal prolapse was noted in all male patients and in 79 % of female patients. Muscular and neuronal defects were detected in 94 and 90 % of the specimens, respectively. Only four specimens (4 %) were free of significant structural defects.ConclusionRectal prolapse traumatizes the rectum causing neuromuscular defects. The tissue trauma is due to shearing forces and ischemia caused by the intussusception. This initiates a self-reinforcing vicious circle of physical and functional obstruction, further impairing rectal evacuation and causing constipation and incontinence. The correlation between extent of prolapse and age suggests that internal rectal prolapse can be considered a degenerative disorder. Neural and motor defects in the wall of the rectum caused by rectal prolapse are likely irreversible.

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Section: Discussionmentioning

confidence: 99%

Rectal prolapse traumatizes rectal neuromuscular microstructure explaining persistent rectal dysfunction

Kraemer¹,

Paulus

Kara³

et al. 2016

Int J Colorectal Dis

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“…Anorectal motor function was evaluated with a perfused sleeve and multiport anorectal assembly incorporating a highly compliant polyethylene bag located in the rectum. Anorectal pressures were recorded under resting conditions and in response to squeeze and increased intra-abdominal pressure [8,10].…”

Section: Anorectal Functionmentioning

confidence: 99%

“…The pathophysiology of anorectal dysfunction after EBRT for carcinoma of the prostate is not fully characterized. Weakness of the external anal sphincter (EAS) and the internal anal sphincter (IAS), decreased rectal compliance, increased rectal sensitivity and faster distal colonic transit have all been implicated [8][9][10]. However, it remains uncertain whether the underlying etiology of the radiation-induced anorectal dysfunction is predominantly myogenic or neurogenic in nature.…”

Section: Introductionmentioning

confidence: 99%

Pudendal nerve injury impairs anorectal function and health related quality of life measures ≥2 years after 3D conformal radiotherapy for prostate cancer

et al. 2017

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“…129 Predicting and reporting toxicity Future systems to predict toxicity will likely include single nucleotide polymorphisms (SNPs) of implicated genes, such as TGFB1, FSHR and XRCC3 as well as mutations on chromosome 11q14.3, which contains SNPs (rs7120482 and rs17630638) for gene products associated with DNA repair. [130][131][132][133][134] Other factors that will be incorporated into prediction models include relevant patient comorbidities (such as diabetes mellitus and colonic dysmotility), 135,136 previous surgical interventions (such as abdominal surgery and transurethral resection of the prostate), 135 medications (such as ADT) 137 and dose-volume histograms. 138 The inclusion of such factors will help to develop risk profiles that will enable clinicians to tailor radiation doses to particular subvolumes.…”

Section: Carbon-12mentioning

confidence: 99%

Evolution of advanced technologies in prostate cancer radiotherapy

et al. 2013

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Conventional treatment options for clinically localized, low-risk prostate cancer include radical prostatectomy, external-beam radiotherapy (EBRT) and low-dose-rate brachytherapy. Advances in image-guided radiotherapy (IGRT) since the 1980s, the development of intensity-modulated radiotherapy (IMRT) during the 1990s and evidence from radiobiological models--which support the use of high doses per fraction--have developed alongside novel advanced radiotherapy modalities that include high-dose-rate brachytherapy (HDR-BT), stereotactic body radiotherapy (SBRT) and proton beam therapy. The relationship between the outcomes of and toxicities experienced by patients with prostate cancer treated with HDR-BT, SBRT and particle-beam therapy should provide urologists and oncologists an understanding of the continually evolving technology in prostate radiotherapy. On the basis of published evidence, conventionally fractionated EBRT with IMRT is considered the standard of care over conventional 3D conformal radiotherapy, whereas HDR-BT boost is an acceptable treatment option for selected patients with intermediate-risk and high-risk prostate cancer. SBRT and proton therapy should not be used for patients (regardless of disease risk group) outside the setting of a clinical trial. Finally, comparative effectiveness research should be conducted to provide a framework for evaluating advanced radiotherapy technologies by comparing the benefits and harms of available therapeutic options to optimize the risk:benefit ratio and improve cost effectiveness.

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Disturbed Colonic Motility Contributes to Anorectal Symptoms and Dysfunction After Radiotherapy for Carcinoma of the Prostate

Cited by 19 publications

References 25 publications

Rectal prolapse traumatizes rectal neuromuscular microstructure explaining persistent rectal dysfunction

Rectal prolapse traumatizes rectal neuromuscular microstructure explaining persistent rectal dysfunction

Pudendal nerve injury impairs anorectal function and health related quality of life measures ≥2 years after 3D conformal radiotherapy for prostate cancer

Evolution of advanced technologies in prostate cancer radiotherapy

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