Urinary and sexual dysfunction after rectal cancer treatment

Abstract

In light of the improving prognosis for patients with rectal cancer, the quality of functional outcome has become increasingly important. Despite the good functional results achieved by expert surgeons, large multicenter studies show that urogenital dysfunction remains a common problem after rectal cancer treatment. More than half of patients experience a deterioration in sexual function, consisting of ejaculatory problems and impotence in men and vaginal dryness and dyspareunia in women. Urinary dysfunction occurs in one-third of patients treated for rectal cancer. Surgical nerve damage is the main cause of urinary dysfunction. Radiotherapy seems to have a role in the development of sexual dysfunction, without affecting urinary function. Pelvic autonomic nerves are especially at risk in cases of low rectal cancer and during abdominoperineal resection. Data concerning nerve damage during laparoscopic surgery for resection of rectal cancer are awaited. Structured education of surgeons with regard to pelvic neuroanatomy, and systematic registration of identified nerves, could well be the key to improving functional outcome for these patients. Meanwhile, patients should be informed of all associated risks before their operation, and their functional status should be evaluated before and after surgery.

Whole mount microscopic sections reveal that Denonvilliers' fascia is one entity and adherent to the mesorectal fascia; implications for the anterior plane in total mesorectal excision?

“…1,2 It has been shown that suboptimal TME leads to a higher risk of tumour involvement of the circumferential resection margin (CRM) affecting the oncological outcome 3,4 and iatrogenic damage of the nerves resulting in an impaired functional outcome. [5][6][7] Therefore, excellent anatomical knowledge of the rectum and surrounding structures is essential to perform an optimal TME.…”

Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer

“…18,19 Duran et al 20 noted a 17.8% decrease in the sexual function of men compared with the preoperational period after abdominoperineal resection and low anterior resection. Both erection and ejaculation were impaired significantly.…”

Neoadjuvant treatment for rectal cancer—A value‐based proposition

“…In men, long-term impairment in sexual function is also common after MMT. Although predominantly caused by surgical injury to the pelvic splanchnic nerves, XRT can result in additive morbidity [31][32][33]. Urinary dysfunction (both retention and incontinence) is also significantly worsened by the addition of XRT.…”