Urinary dysfunction after colorectal cancer treatment and impact on quality of life—a national cross‐sectional study in males

Abstract

Aim Despite advances in the treatment of colorectal cancer, postoperative urogenital dysfunction is still a problem although its exact extent remains unclear. The aim of this study was to identify the prevalence and patterns of urinary dysfunction in men following treatment for colorectal cancer and the impact of urinary dysfunction on quality of life. Method A retrospective national Danish cross‐sectional study was performed in patients treated for colorectal cancer between 2001 and 2014. Patients answered questionnaires on urinary function and quality of life including the International Consultation on Incontinence Modular Questionnaire—Male Lower Urinary Tract Symptoms measuring voiding and incontinence. Results were analysed based on data on demographics and treatment‐related factors obtained from the Danish Colorectal Cancer Group database. Results A total of 5710 patients responded to the questionnaire (response rate 52.8%). In both crude analysis and after adjusting for patient‐related factors (age, time since surgery and American Society of Anesthesiologists score), both voiding (P < 0.0001) and incontinence scores (P < 0.0001) were significantly higher after rectal cancer than after colon cancer. In the rectal cancer group, abdominoperineal excision was found to be a significant risk factor for both voiding (P < 0.0001) and incontinence (P = 0.011), while radiotherapy only impaired continence (P = 0.014). Significant correlations between high voiding and incontinence scores and impaired quality of life were found in both groups. Conclusion We found a high prevalence of urinary dysfunction following treatment for colorectal cancer, especially in the rectal cancer group. Abdominoperineal excision was the most significant risk factor for both voiding and incontinence. Urinary dysfunction significantly impairs patients' quality of life.

Chronic pain after colon cancer surgery: Translation and validation of a scoring system

“…This improvement is seen not only in the Western world but also in other geographical areas where high-quality care is available [2]. A growing number of CRC survivors suffer from a broad spectrum of late sequelae, including bowel, urinary, sexual dysfunction, fatigue, psychological distress, insomnia, and pain, all of which may severely affect the quality of life (QoL) [3][4][5][6][7][8][9]. Severe persistent postsurgical pain is a…”

Multi-Disciplinary Management in Rectal Cancer Survivorship: A Clinical Practice Review

“…The mechanism of injury leading to urinary dysfunction is thought to be secondary to nerve damage during surgical resection of rectal tumors [53]. Studies have suggested worse urinary function in patients undergoing APR compared to those undergoing LAR; however, when controlled for other risk factors, these were not statistically significant [52,54,55]. The research on the impact of radiation on urinary dysfunction in rectal cancer survivors is mixed [51,54,56].…”

Management of treatment‐related sequelae following colorectal cancer

“…Similarly, a large cross‐sectional study on male CRC survivors ( n = 5710; colon n = 3400, rectum n = 2310) found that urinary dysfunction had a significant impact on QoL in 15.8% of RC survivors and 13.6% of CC survivors ( p = 0.017) [132] (2b). Rectal resection seems to be an independent risk factor for developing urinary dysfunction with abdominoperineal excision and/or RT increasing the risk even further [110, 129,131–133] (2b). However, one study reported the urinary symptoms induced by RT to affect men only and to be transient [125] (2b).…”

“…However, one study reported the urinary symptoms induced by RT to affect men only and to be transient [125] (2b). Other risk factors include low tumour height (<5 cm from the anal verge), lymph node involvement, preoperative urinary dysfunction and advanced age [125, 131, 132, 134] (2b).…”