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Zhu KJ, Thanigasalam R, Solomon MJ. Preoperative urinary function does not predict postoperative acute urinary retention in men after rectal resection. Colorectal Dis 2020; 22:2260-2269. [PMID: 32691944 DOI: 10.1111/codi.15280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022]
Abstract
AIM Acute urinary retention (AUR) is a well-known complication after rectal surgery. It can be associated with additional morbidity. Causes of postoperative AUR are often multifactorial - involving patient-, pathology- and treatment-related factors. A proportion of men undergoing total mesorectal excision (TME) have preexisting urinary dysfunction and this may predispose to AUR. The aim of this study was to prospectively assess the influence of preoperative urinary function on postoperative AUR in men undergoing TME. METHOD A prospective multicentre cohort study was conducted. All adult men undergoing rectal resection between June 2016 and January 2018 were recruited. Combined pelvic resections, inability to void per urethra and emergency surgery were excluded. Preoperative urinary function was assessed with uroflowmetry, prostate ultrasound and the International Prostate Symptom Score (IPSS). The incidence of postoperative AUR, urinary tract infection (UTI) and length of hospital stay (LOS) were measured. RESULTS Seventy-seven patients (mean age 61 years) were recruited. The overall incidence of AUR was 21%. Preoperative urinary function, IPSS and past urological history were not predictive for postoperative AUR. AUR was not associated with UTI and did not affect LOS. Patients with UTI had a higher intravesical protrusion of the prostate. CONCLUSION Preoperative urinary dysfunction in men is not predictive of postoperative AUR after TME. It should not preclude early trial of void after TME. AUR did not predispose to UTI, nor did it prolong LOS.
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Affiliation(s)
- K J Zhu
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, University of Sydney, Sydney, New South Wales, Australia
| | - R Thanigasalam
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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2
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Zanolla R, Campo B, Ordesi G, Martino G. Bladder Urethral Dysfunction after Abdominoperineal Resection of the Rectum for Anorectal Cancer. TUMORI JOURNAL 2018; 70:555-9. [PMID: 6531798 DOI: 10.1177/030089168407000614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We prospectively studied bladder and urethral function in 44 patients before and after abdominoperineal resection of the rectum for ano-rectal cancer. The patients were investigated with the following examinations: combined cystometry and electromyography, urethral pressure profile measurement, urecholine denervation test, urine culture, urethrogram and residual urine measurement after voiding. Urodynamic results after surgery demonstrated the partial or total denervation of the detrusor muscle with bladder areflexia in the 54% of the cases, the decrease in the urethral pressure profile in the 48% of the cases, and the absence of detrusor sphincter dyssynergia in all cases. Urethrogram results showed a high incidence of bladder dislocation into the presacral space (36%). Urine cultures were frequently positive in 52% of the patients. Most patients (52%) had difficulty in voiding with high residual urine and/or stress incontinence (4.5%). All the patients received an early rehabilitative treatment with kinesitherapy and/or pharmacologic therapy after bladder catheter removal and after urodynamic results. The patients with neurogenic bladder with residual urine volume had satisfactory functional recovery of the activity.
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3
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Grama F, Van Geluwe B, Cristian D, Rullier E. Urogenital dysfunctions after treatment of rectal cancer. COLORECTAL CANCER 2015. [DOI: 10.2217/crc.15.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A significant part of rectal cancer survivors will experience urogenital dysfunction induced by the treatment. Significant progress has been made in order to improve the total mesorectal technique through different approaches (open, laparoscopic, robotic, transanal). Rectal cancer surgery is technically difficult notably deep in the pelvis, and therefore the most frequent cause of the postoperative dysfunction is the surgical nerve damage of the autonomic nerves at this level. The main objectives of these efforts were to obtain maximal oncological results and to achieve better functional outcomes including less postoperative urogenital dysfunctions. Our purpose was to build a comprehensive review of the existing literature data regarding this issue from past to present.
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Affiliation(s)
- Florin Grama
- Department of General Surgery, Colţea Clinical Hospital & Carol Davila University of Medicine & Pharmacy, Bucharest, Romania
| | - Bart Van Geluwe
- Department of Surgery, Colorectal Unit, CHU Bordeaux, Saint-André Hospital, Bordeaux, France
| | - Daniel Cristian
- Department of General Surgery, Colţea Clinical Hospital & Carol Davila University of Medicine & Pharmacy, Bucharest, Romania
| | - Eric Rullier
- Department of Surgery, Colorectal Unit, CHU Bordeaux, Saint-André Hospital, Bordeaux, France
- Segalen University, Bordeaux, France
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4
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Kneist W, Junginger T. Long-term urinary dysfunction after mesorectal excision: A prospective study with intraoperative electrophysiological confirmation of nerve preservation. Eur J Surg Oncol 2007; 33:1068-74. [PMID: 17524598 DOI: 10.1016/j.ejso.2007.03.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Accepted: 03/29/2007] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bladder dysfunctions are well-recognized complications after nerve-sparing mesorectal excision for rectal cancer. This study sought to symptomatically analyze the extent of recovery from major and minor urinary symptoms in patients with signs of bladder denervation. METHODS Sixty-two patients with mesorectal excision for rectal cancer were investigated prospectively. Pelvic autonomic nerve preservation (PANP) was assessed macroscopically and with the aid of intraoperative electrical stimulation of pelvic autonomic nerves (INS). Bladder function was evaluated with the International Prostate Symptom Score (IPSS) and the Quality of life index (Qol). Median follow-up was 20 months (range 3-40 months). RESULTS Forty-six patients with INS-confirmed preservation of parasympathetic nerves remained unchanged in early and long-term urinary function (IPSS: median 1; range 0-24 and Qol 0; range 0-5). In 15 patients without confirmation of PANP (unilaterally or bilaterally) on INS, voiding function was significantly more impaired postoperatively (IPSS: median 10; range 0-25 and Qol 3; range 0-6) and at long-term follow-up (IPSS: median 9; range 0-25 and Qol 3; range 0-6) (p<0.001). Voiding function was improved in 4 of 10 patients with major and minor symptoms. In 5 of 6 patients with long-term bladder dysfunction INS assessed parasympathetic nerve damage unilaterally (3/5) and bilaterally (2/5). CONCLUSION Long-term voiding disturbance after mesorectal excision was found to be a serious complication. INS while monitoring intravesical pressure is a valuable aid in predicting long-term bladder function after TME. The device may serve a secondary preventive function in enabling the initiation of early urologic therapy.
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Affiliation(s)
- W Kneist
- Clinic of General and Abdominal Surgery, Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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5
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Abstract
When total mesorectal excision (TME) is accurately performed, dysfunction, theoretically, does not occur. However, there are differences among individuals in the running patterns and the volumes of nerve fibers, and if obesity or a narrow pelvis is present, nerve identification is difficult. Currently, the rate of urinary dysfunction after rectal surgery ranges from 33% to 70%. Many factors other than nerve preservation play a role in minor incontinence. Male sexual function shows impotence rates ranging from 20% to 46%, while 20%-60% of potent patients are unable to ejaculate. In women, information on sexual function is not easily obtained, and there are more unknown aspects than in men. As urinary, sexual, and defecation dysfunction due to adjuvant radiotherapy have been reported to occur at a high frequency, the creation of a protocol that enables analysis of long-term functional outcome will be essential for future clinical trials. In the treatment of rectal cancer, surgeon-related factors are extremely important, not only in achieving local control but also in preserving function. This article reviews findings from recent studies investigating urinary, sexual, and defecation dysfunction after rectal cancer surgery and discusses questions to be studied in the future.
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Affiliation(s)
- Yoshihiro Moriya
- Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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6
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Ameda K, Kakizaki H, Koyanagi T, Hirakawa K, Kusumi T, Hosokawa M. The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer. Int J Urol 2005; 12:256-63. [PMID: 15828952 DOI: 10.1111/j.1442-2042.2005.01026.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present study is to symptomatically analyze the extent to which pelvic nerve-sparing radical surgery for rectal cancer impacts on long-term voiding and male sexual function. METHODS A self-administered questionnaire was mailed to 68 patients who underwent pelvic nerve-sparing radical surgery for invasive rectal cancer with 52 responses (28 men and 24 women; 27 complete and 25 incomplete preservation; response rate 76.5%). Each patient was asked to record if there had been any changes in lower urinary tract symptoms after surgery. Sexual function was also investigated in men. RESULTS Of the 52 patients, 48 (92%) maintained voluntary voiding without catheterization in the long term. Clean intermittent self-catheterization was performed in only four patients with incomplete preservation because of persistent voiding dysfunction. Subjectively, approximately 60% of the patients remained unchanged in lower urinary tract symptoms after surgery. The satisfaction rate regarding the current voiding status was significantly higher in women than in men (83% versus 61%, P = 0.0294), but was not significantly different between those with complete (76%) and incomplete preservation (64%). Despite the acceptable urinary status, 88% of men had some deterioration in the erectile function, regardless of the types of surgical procedures. Overall, 64% of men were unsatisfied with the current sexual function. CONCLUSIONS Pelvic nerve-sparing radical surgery for rectal cancer preserved the long-term voiding function in the majority of patients. In completely preserved patients and in women, symptomatic outcomes were more satisfactory. Postoperative erectile dysfunction was found to be a serious problem, even in complete nerve-sparing procedure.
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Affiliation(s)
- Kaname Ameda
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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7
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Abstract
The present scarcity of literature on laparoscopic rectal cancer surgery makes it premature to determine whether laparoscopic surgery should be the standard of care for rectal cancer. Notwithstanding that, the available evidence proves its safety and adequate oncological clearance. Moreover, current data do not suggest any detrimental effect on the postoperative and early oncological outcomes. On the contrary, there is level three evidence showing that laparoscopic technique results in less blood loss, shorter length of stay, and reduced abdominal wound disorders and pulmonary complications, albeit the overall morbidity remains similar to that of open surgery. Long-term survival outcomes remain largely unclear, however. Hence, it is high time that laparoscopic technique should be further evaluated, preferably by means of large-scale randomized trials, to define its exact role in the treatment of rectal cancer.
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Affiliation(s)
- W W C Tsang
- Minimal Access Surgery Training Centre, Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
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8
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Del Río C, Sánchez-Santos R, Oreja V, De Oca J, Biondo S, Parés D, Osorio A, Martí-Ragué J, Jaurrieta E. Long-term urinary dysfunction after rectal cancer surgery. Colorectal Dis 2004; 6:198-202. [PMID: 15109387 DOI: 10.1111/j.1463-1318.2004.00624.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Urinary dysfunction is a well-known complication of rectal surgery, secondary to injury to the autonomic nervous plexus. The object of this study was to evaluate the incidence, prevalence and type of micturition disorders following rectal cancer surgery and their reversibility during long-term follow-up. PATIENTS AND METHODS A prospective study of 45 patients who underwent surgery for rectal cancer between 1993 and 1998 was undertaken. Those with pre-operative urinary dysfunction were excluded after sequential uroflowmetry and clinical interview. Ten of the surgical interventions were high anterior resections, 18 low anterior resections, and 17 abdominoperineal amputations. Pre-operative radiotherapy was performed in 47.9% of patients. All patients underwent sequential uroflowmetry and a clinical interview 3 and 12 months after the intervention. Subjects who presented micturition disorders underwent urodynamic examination The follow up period was three years. RESULTS Three months after surgery alterations were found in 14 (31.3%) patients; the most frequent were stress incontinence, urinary tenesmus and the urge to urinate. At the 12-month assessment only 6 (13.3%) patients had urinary symptomatology or uroflowmetry abnormalities. After three years, micturition disorders persisted in 3 (6.6%) patients. CONCLUSION Urinary dysfunction after rectal cancer excision is associated with a high degree of reversibility. Seventy-eight percent of the alterations detected after three months and 50% of those that persisted after a year disappeared during follow up.
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Affiliation(s)
- C Del Río
- Department of Coloproctology, Department of Digestive Surgery, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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9
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Ali M, Johnson IP, Hobson J, Mohammadi B, Khan F. Anatomy of the pelvic plexus and innervation of the prostate gland. Clin Anat 2004; 17:123-9. [PMID: 14974100 DOI: 10.1002/ca.10187] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We have examined the anatomy of the pelvic (inferior hypogastric) plexus in six male cadavers, paying particular attention to gross anatomical landmarks that might aid in locating it and have used immunohistochemistry to study the small branches of the plexus that supply the prostate gland. The pelvic plexus was found two finger breadths lateral to the third anterior sacral foramina, lying deep to a line drawn from third sacral vertebra, the conventional level of the recto-sigmoid junction, and the palpable posterior superior surface of the pubic symphysis. Immunohistochemical staining showed small nerve branches from the pelvic plexus entering the prostate gland and the presence of ganglia within the prostate gland that contained both tyrosine hydroxylase positive and negative neuronal cell bodies. This information may be useful in nerve-sparing surgical procedures and in discussions of the functional implications of perturbations of prostate innervation.
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Affiliation(s)
- M Ali
- Department of Anatomy and Developmental Biology, Royal Free and University College Medical School, University College London, United Kingdom
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10
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Abstract
A variety of common, gastrointestinal diseases result in significant genitourinary tract pathology. In general, knowledge of these associated disease processes permit rapid and accurate diagnosis and treatment. The underlying thread is the recognition of one pathophysiological process to explain patterns of a single disease.
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Affiliation(s)
- Michael G Oefelein
- Case Western Reserve University, School of Medicine, University Urologists of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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11
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Mannaerts GH, Schijven MP, Hendrikx A, Martijn H, Rutten HJ, Wiggers T. Urologic and sexual morbidity following multimodality treatment for locally advanced primary and locally recurrent rectal cancer. Eur J Surg Oncol 2001; 27:265-72. [PMID: 11373103 DOI: 10.1053/ejso.2000.1099] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIMS In the treatment of patients with locally advanced primary or locally recurrent rectal cancer much attention is given to the oncological aspects. In long-term survivors, urogenital morbidity can have a large effect on the quality of life. This study evaluates the functional outcome after multimodality treatment in these patient groups. PATIENTS AND METHODS Between 1994 and August 1999, 55 patients with locally advanced primary and 66 patients with locally recurrent rectal cancer were treated with multimodality treatment: i.e. high-dose preoperative external beam radiation therapy, followed by extended surgery and intraoperative radiotherapy. The medical records of the 121 patients were reviewed. To assess long-term urogenital morbidity, all patients still alive, with a minimum follow-up of 4 months, were asked to fill out a questionnaire about their voiding and sexual function. Seventy-six of the 79 currently living patients (96%) returned the questionnaire (median FU 14 months, range 4-60). RESULTS The questionnaire revealed identifiable voiding dysfunction as a new problem in 31% of the male and 58% of the female patients. In 42% of patients after locally advanced primary and 48% after locally recurrent rectal cancer treatment bladder dysfunction occurred. The preoperative ability to have an orgasm had disappeared in 50% of the male and 50% of the female patients, and in 45% of patients after locally advanced primary and in 57% after locally recurrent rectal cancer treatment. CONCLUSION Multimodality treatment for locally advanced primary and recurrent rectal cancer results in acceptable urogenital dysfunction if weighed by the risk of uncontrolled tumour progression. Long-term voiding and sexual function is decreased in half of the patients. Preoperative counselling of these patients on treatment-related urogenital morbidity is important.
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Affiliation(s)
- G H Mannaerts
- Catharina Hospital, Department of Surgery, Eindhoven, The Netherlands
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12
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Matsuoka N, Moriya Y, Akasu T, Fujita S. Long-term outcome of urinary function after extended lymphadenectomy in patients with distal rectal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:165-9. [PMID: 11289753 DOI: 10.1053/ejso.2000.1064] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Extended lymphadenectomy for rectal cancer has been superseded by autonomic nerve-sparing surgery, but it still has historical significance. It is useful to document the long-term outcome of urinary function in cases who had resection of the inferior hypogastric nerve plexus (pelvic nerve plexus). METHODS The long-term urinary function following extended lymphadenectomy was studied retrospectively through the medical records of 83 patients who had been followed-up for more than 5 years after surgery. RESULTS Forty-four per cent of the male patients and 17% of the female patients had to perform clean intermittent self-catheterization (CIC) for more than 1 year; these rates were almost the same at 3 years after the procedure. Urinary incontinence was reported in 34% of the male patients and 45% of the female patients. Complicated cystitis (eight patients), complicated pyelonephritis (two patients), bladder stones (five patients) that required surgical treatment, and chronic renal failure (two patients) were considered as adverse outcomes of extended surgery. In particular, one case needed to undergo urinary diversion. CONCLUSIONS A surprisingly large proportion of patients suffered various urinary tract problems due to extended lymphadenectomy. The findings demonstrate the importance of selection of well-balanced operations that can encompass both radicality and quality of life. The extent of resection should be decided by the extent of the cancer and routine excision of the inferior hypogastric nerve plexus should not be performed.
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Affiliation(s)
- N Matsuoka
- Department of Urology and Department of Surgery, National Cancer Center, Tokyo, Japan
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13
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Maas CP, Moriya Y, Steup WH, Klein Kranenbarg E, van de Velde CJ. A prospective study on radical and nerve-preserving surgery for rectal cancer in the Netherlands. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:751-7. [PMID: 11087640 DOI: 10.1053/ejso.2000.0998] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Preservation of the pelvic autonomic nerves is thought to lower bladder and sexual dysfunction after rectal cancer surgery. A prospective study was undertaken in a Dutch population to evaluate functional outcome, local recurrence and survival of a Japanese operative technique combining nerve preservation with radical tumour resection. METHODS Forty-seven patients were operated upon by a Japanese surgeon. Voiding and sexual function were prospectively analysed using questionnaires. Two-year follow-up on urinary function was complete in 73%, and 2-year follow-up of male sexual function was complete in 77%. Median follow-up for survival and recurrence was 42 months and was complete in all patients. RESULTS Five patients (19%) developed minor urinary incontinence in the period between 1 and 2 years of follow-up. Six patients (22%) had a persistently elevated frequency of voiding. There was no statistically significant correlation between the extent of nerve preservation and the reported minor voiding dysfunctions. None of the patients reported major incontinence of urine. Impotence was related to sacrifice of the inferior hypogastric plexus and ejaculatory dysfunction was related to sacrifice of the superior hypogastric plexus. Sexual function did not change during follow-up. Of 42 curatively-operated patients, three (7.1%) developed local recurrence. Sixty-seven per cent were overall free of recurrence. Disease-free survival was 57%. CONCLUSIONS Preservation of the pelvic autonomic nerves minimizes bladder dysfunction after rectal cancer surgery. The preservation of the total autonomic nerve system is essential for normal sexual function in male patients. Nerve preservation does not compromise radicality in mesorectal excision. Mesorectal excision should involve identification and preservation of the pelvic autonomic nerves.
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Affiliation(s)
- C P Maas
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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14
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Lindsey I, Guy RJ, Warren BF, Mortensen NJ. Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 2000; 87:1288-99. [PMID: 11044153 DOI: 10.1046/j.1365-2168.2000.01542.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The development and anatomy of Denonvilliers' fascia have been controversial for many years and confusion exists about its operative appearance. Better appreciation of this poorly understood anatomy, and its significance for impotence after rectal dissection, may lead to further functional improvements in pelvic surgery. METHOD A literature review of the embryology and anatomy of Denonvilliers' fascia and impotence after pelvic rectal surgery was undertaken. RESULTS Denonvilliers' fascia has no macroscopically discernible layers. The so-called posterior layer refers to the fascia propria of the rectum. The incidence of erectile and ejaculatory dysfunction after rectal excision is high in older patients, and when performed for rectal cancer. There is no consensus about the relationship of Denonvilliers' fascia to the plane of anterior dissection for rectal cancer. CONCLUSION Colorectal surgeons should focus on the important anatomy between the rectum and the prostate to improve functional outcomes after rectal excision. A classification of the available anterior dissection planes is proposed. Surgeons should be encouraged to document the plane used as well as outcome in terms of sexual function.
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Affiliation(s)
- I Lindsey
- Departments of Colorectal Surgery and Cellular Pathology, John Radcliffe Hospital, Oxford, UK
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15
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Mitsui T, Shinno Y, Kobayashi S, Matsuura S, Shibata T, Ameda K, Koyanagi T. Persistent vesicourethral dysfunction following radical surgery for rectal carcinoma: urodynamic features and potential abatement with modified sphincterotomy (radical transurethral resection of the prostate). Int J Urol 1998; 5:39-43. [PMID: 9535599 DOI: 10.1111/j.1442-2042.1998.tb00232.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vesicourethral function returns after radical rectal surgery during the first year but rarely progresses after 1 year. We examined the urodynamics of patients whose voiding dysfunction remained after 1 year, and treated several with a modified sphincterotomy procedure similar to radical transurethral resection of the prostate. METHODS We analyzed the urodynamic features of vesicourethral dysfunction in 16 male patients with persistent voiding dysfunction for more than 1 year following radical surgery for rectal carcinoma. Seven patients elected to undergo radical transurethral resection of prostate (radical TUR-P) for the relief of their persistent voiding dysfunction. RESULTS The mean bladder volume at the first desire to void was 210 mL, the mean maximal bladder capacity was 343 mL, and the mean vesical compliance (Cves) was 27.1 mL/cm H2O. All patients demonstrated either vesical denervation supersensitivity (Vds) or uninhibited contraction. The mean maximal urethral closure pressure was 43.9 cm H2O, and urethral denervation supersensitivity was found in 77.8% (7/9), and sphincter dyssynergia in 66.7% (6/9) of patients. After radical TUR-P, 5 patients became free from the use of self-catheterization, 1 patient had a reduced residual urine rate, and 1 patient was unchanged, but no patient noted a change in urinary control. CONCLUSION Urethral dysfunction after radical rectal surgery was caused by failure of the bladder to empty along with an underactive detrusor. Radical TUR-P was effective in restoring voiding function in a selected group of these patients.
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Affiliation(s)
- T Mitsui
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan
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16
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Maas CP, Moriya Y, Steup WH, Kiebert GM, Kranenbarg WM, van de Velde CJ. Radical and nerve-preserving surgery for rectal cancer in The Netherlands: a prospective study on morbidity and functional outcome. Br J Surg 1998; 85:92-7. [PMID: 9462393 DOI: 10.1046/j.1365-2168.1998.00530.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Operative procedures for primary rectal cancer from Japan combine pelvic nerve-preserving techniques with radical tumour resection to ensure optimal local tumour control with minimal bladder and sexual dysfunction. A prospective study was undertaken to evaluate morbidity and functional outcome of such a technique in Dutch patients. METHODS Forty-seven patients were operated on by a Japanese surgeon. Postoperative course was monitored. Voiding and sexual function were analysed using questionnaires completed by patients. RESULTS After operation, only prolonged paralytic ileus (five of 47 patients) and perineal wound dehiscence (five of 18) occurred more frequently than reported in literature. There were no deaths. No patient developed urinary incontinence. Three of 11 women and 19 of 30 men were sexually active. Two men were impotent after operation. Impotence was related to sacrifice of the inferior hypogastric plexus (P = 0.037). Preservation of the superior hypogastric plexus was crucial for ejaculation (P = 0.003). CONCLUSION A relationship between sacrifice of specific nerve structures and accompanying dysfunction was established. The nerve-preserving technique yields good results in terms of morbidity and functional outcome, and should be considered for adoption as a standard surgical procedure for primary rectal cancer.
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Affiliation(s)
- C P Maas
- Department of Surgery, University Hospital Leiden, The Netherlands
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17
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Mitsui T, Kobayashi S, Matsuura S, Kakizaki H, Mori T, Minami S, Koyanagi T. Vesicourethral dysfunction following radical surgery for rectal carcinoma: change in voiding pattern on sequential urodynamic studies and impact of nerve-sparing surgery. Int J Urol 1998; 5:35-8. [PMID: 9535598 DOI: 10.1111/j.1442-2042.1998.tb00231.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Urodynamic studies were performed to clarify vesicourethral dysfunction and recovery after rectal surgery for cancer. MATERIALS AND METHODS At 1, and 6 to 1 2 months after rectal surgery interviews and urodynamic studies (UDS) were performed on 51 consecutive patients, all without a prior history of voiding disorder (40 males and 11 females; median age, 60 years). Patients were divided into 2 groups, either with (preserved group, n = 17) or without (nonpreserved group, n = 34) preservation of the bilateral pelvic plexus during surgery. Comparisons of voiding status and urodynamic parameters were made between the 2 groups. RESULTS By 1 and 6 months after the operation normal voiding was achieved in 71% (12/17) and 100% (13/13) of patients in the preserved group, and 6% (2/34) and 30% of patients (9/30) in the nonpreserved group, respectively (P < 0.001). Attainment of normal voiding in the nonpreserved group was preceded by the recovery of bladder sensation, while UDS demonstrated increases in vesical compliance and the disappearance of vesical denervation supersensitivity. CONCLUSION A nerve-sparing procedure during radical surgery for rectal carcinoma preserved vesicourethral function. The urodynamic parameters relevant to postoperative recovery of voiding function were improved vesical compliance, disappearance of vesical denervation supersensitivity, and recovery of a bladder filling sensation.
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Affiliation(s)
- T Mitsui
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan
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Faraj AA, Webb JK, Lemberger RJ. Urinary bladder dysfunction following anterior lumbosacral spine fusion: case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1996; 5:121-4. [PMID: 8724192 DOI: 10.1007/bf00298391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A 34-year-old woman suffering from chronic degenerative low back pain involving L5-S1 disc space, refractory to conservative treatment, underwent spinal fusion. A combined instrumented posterolateral, followed by anterior, interbody allograft fusion through a left retroperitoneal approach was performed. Postoperatively, the patient was unable to evacuate her bladder and control her micturition. Anal tone and sensation were intact. A self-catheterisation regime was instituted with a diagnosis of parasympathetic nerve injury during the anterior spinal fusion. After a period of 3 months, the patient regained control of urination. We report this case to highlight the importance of protecting the parasympathetic presacral nerve during L5-S1 anterior interbody fusion, as injury to this nerve affects urinary evacuation.
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Affiliation(s)
- A A Faraj
- Centre of Spinal Studies and Surgery, University Hospital, Nottingham, Nottinghamshire, UK
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19
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Leveckis J, Boucher NR, Parys BT, Reed MW, Shorthouse AJ, Anderson JB. Bladder and erectile dysfunction before and after rectal surgery for cancer. BRITISH JOURNAL OF UROLOGY 1995; 76:752-6. [PMID: 8535720 DOI: 10.1111/j.1464-410x.1995.tb00768.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To establish the incidence of bladder and erectile dysfunction after rectal surgery for cancer. PATIENTS AND METHODS Twenty patients (16 men and four women, median age 66 years, range 36-78) with carcinoma of the rectum were prospectively studied immediately before and 4 months after operation by clinical assessment, uroflowmetry and video-cystometrography. All patients were catheterized routinely at the time of surgery. Those experiencing voiding difficulties after catheter removal were managed by intermittent self-catheterization or an indwelling urethral catheter. RESULTS Before surgery, only six patients had completely normal bladder function and 13 of the 16 men were at least partially potent. Eight of the 19 patients who eventually had surgery developed identifiable bladder dysfunction, of whom three had urodynamic evidence of complete bladder denervation. Three men who were potent before became impotent after surgery. CONCLUSIONS Bladder and erectile dysfunction are recognized complications of radical rectal surgery, although there is significant variation in the reported risk; much of this variability is related to the retrospective nature of most previous studies. This study demonstrates the importance of prospective urodynamic evaluation and confirms that the small but significant risk of permanent bladder dysfunction is likely to be related to pelvic nerve injury at the time of surgery.
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Affiliation(s)
- J Leveckis
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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20
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Ralph DJ, Woodhouse CR, Ransley PG. The management of the neuropathic bladder in adolescents with imperforate anus. J Urol 1992; 148:366-8. [PMID: 1635137 DOI: 10.1016/s0022-5347(17)36598-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The management of 58 patients born with an imperforate anus who presented to the urology service and who are currently 18 years old or older is discussed. Of the 44 patients with a high imperforate anus 43 were treated by a rectal pull-through and 1 by an anal cut back procedure, while an anal cut back procedure was used in all 14 children with a low imperforate anus. A total of 32 children (55%) had a neuropathic bladder (hyperreflexic in 29 and atonic in 3). A spinal deformity was present in 72% of the hyperreflexic group but not in the atonic group. Vesicoureteral reflux occurred in 41% of the patients, two-thirds of whom had a neuropathic bladder. A total of 30 children had an associated genital anomaly and 27 had an upper tract anomaly. Nineteen children underwent an operation for the neuropathic bladder, with modern reconstructive methods involving substitution or augmentation cystoplasty, supplemented with self-catheterization, being superior to older methods with regard to continence. The incidence of a neuropathic bladder in these children is high in both operative groups but it is usually associated with a spinal deformity and unlikely to be iatrogenic in nature unless proved to be of lower motor neuron origin. Early operative management is advised to achieve continence and minimize renal impairment.
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Affiliation(s)
- D J Ralph
- Institute of Urology, Hospital for Sick Children, London, England
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21
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Peh WC, Chokshi NC, Young CH. The disappearing bladder--modifying imaging techniques after rectal excision. Br J Radiol 1992; 65:442-4. [PMID: 1611426 DOI: 10.1259/0007-1285-65-773-442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- W C Peh
- Department of Diagnostic Radiology, Selly Oak Hospital, Birmingham, UK
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22
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Abstract
Current understanding of the routes of spread of rectal cancer along with technical innovations such as the circular stapler have allowed surgeons to treat most rectal cancers with an anterior resection and low anastomosis. Appropriate use of local therapy options has further decreased the need for abdominoperineal resection (APR). Nonetheless, APR remains the procedure of choice for many distal rectal adenocarcinomas. Numerous factors influence the decision to perform an APR and are discussed in detail. Although mortality for APR has been reduced significantly, morbidity remains high. Specific complications commonly seen after APR are discussed. Operative technique is outlined since much of the specific morbidity of APR can be reduced by attention to detail in the conduct of this complex procedure.
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Affiliation(s)
- D A Rothenberger
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis
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23
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Abstract
Resection of the colon and rectum may produce both transient and permanent alterations in colonic function. Furthermore, the nature of some operative techniques may result in autonomic denervation of the rectum and associated pelvic viscera. An understanding of the mechanism of injury and the subsequent functional abnormalities is necessary to provide adequate therapy.
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Affiliation(s)
- D J Schoetz
- Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts 01805
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24
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Abstract
Sixteen published series were reviewed in which local excision was used as definitive treatment for patients with invasive rectal carcinoma located within 6 cm of the anal verge. Ninety-four percent of tumors were T1 or T2 adenocarcinomas with no identified regional metastases. Five-year cancer-specific survival was 89%. Local recurrence was 19%, although more than half of these patients were cured with additional surgery. These results were comparable with those for historical controls treated with abdominoperineal resection (APR). Four pathologic features of the surgical specimen were analyzed to assess their correlation with patient outcome. Positive surgical margins, poorly differentiated histology, and increasing depth of bowel wall invasion were associated with increased local recurrence and decreased survival. Tumor size greater than 3 cm was not a significant factor. When criteria for appropriate patient selection are followed, local excision may provide survival and recurrence rates comparable with those achieved with APR with less morbidity and operative mortality.
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Affiliation(s)
- R A Graham
- Department of Surgery, New England Medical Center, Boston, Massachusetts 02111
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25
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Morodomi T, Isomoto H, Shirouzu K, Kakegawa K, Irie K, Morimatsu M. An index for estimating the probability of lymph node metastasis in rectal cancers. Lymph node metastasis and the histopathology of actively invasive regions of cancer. Cancer 1989; 63:539-43. [PMID: 2912530 DOI: 10.1002/1097-0142(19890201)63:3<539::aid-cncr2820630323>3.0.co;2-s] [Citation(s) in RCA: 174] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We examined resected specimens from 40 cases of advanced rectal cancer to determine the extent of microtubular cancer nests and undifferentiated cancer cells (budding). We investigated the relationship between this budding and lymphatic invasion (ly), venous invasion (v), and lymph node metastasis (n), respectively. Moreover, we examined the relationship between ly, budding, and n in the preoperative biopsy specimens of 112 patients, including those of the 40 cases mentioned above. The degree of budding, which was abundant in the actively invasive region, showed a strong correlation with the degree of ly and the existence of n in the resected specimens. Also, budding was recognized in a relatively large portion of the biopsy specimens (52 of 112 [46.4%]) and lymph node metastasis was found in 41 of 52 specimens (78.8%). In 57 specimens, neither ly nor budding was found, and 16 of these specimens (28.1%) had positive lymph nodes. These results implied that the degree of budding in the actively invasive region can be a great help in predicting the presence of n. The presence or absence of budding in preoperative biopsy specimens also can be an important factor (along with the degree of differentiation and ly) in estimating the probability of n.
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Affiliation(s)
- T Morodomi
- Department of Surgery and Pathology, Kurume University School of Medicine, Japan
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26
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Burgos FJ, Romero J, Fernandez E, Perales L, Tallada M. Risk factors for developing voiding dysfunction after abdominoperineal resection for adenocarcinoma of the rectum. Dis Colon Rectum 1988; 31:682-5. [PMID: 3168678 DOI: 10.1007/bf02552583] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Voiding dysfunction is a common sequel of abdominoperineal resection of the rectum. Twenty patients symptomatic after abdominoperineal resection, 14 with a preoperative normal urodynamic study and six with evidence of obstruction, were studied postoperatively. The importance of the following factors is analyzed: sex, stage, grade, size, distance of the tumor from the anal verge, metastatic lymph-node involvement, and extent of lymphadenectomy. Male gender, tumors situated between 4 and 8 cm from the anal verge, and lymphadenectomy that includes more than ten nodes may be considered risk factors for neurologic damage and postoperative voiding dysfunction.
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Affiliation(s)
- F J Burgos
- Department of Urology, Ramon y Cajal Hospital, Madrid, Spain
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27
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Leach GE, Yip CM. Delayed bladder dysfunction after abdominoperineal resection: an indicator of local recurrence. Urology 1987; 29:99-101. [PMID: 3798642 DOI: 10.1016/0090-4295(87)90614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
It is generally not appreciated that the delayed onset of voiding dysfunction after abdominoperineal resection for rectal carcinoma may be the first sign of local pelvic recurrence. We herein present a series of 5 patients who were referred for urodynamic evaluation of voiding dysfunction beginning nine to twenty-four months after the original operative procedure. Urodynamic evaluation revealed low bladder wall compliance in 4 patients, and detrusor hyperreflexia in 1 patient. Computerized tomography scans confirmed the local tumor recurrence in all cases. The delayed onset of voiding complaints after abdominoperineal resection should prompt a high index of suspicion that a local tumor recurrence may be present.
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28
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Kwok KY, Blacklock AR, Bullen BR. A prospective study of bladder function following aortic surgery. BRITISH JOURNAL OF UROLOGY 1986; 58:382-6. [PMID: 3756406 DOI: 10.1111/j.1464-410x.1986.tb09090.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty-four patients undergoing aortic surgery for aneurysmal or occlusive aortic disease were studied prospectively to assess the effect on bladder function. Thirteen patients completed the study with post-operative follow-up at 3 months. Aortic surgery was found to be unlikely to cause damage to the parasympathetic nerves. There was no change in the detrusor stability/instability status in five of seven patients undergoing surgery for occlusive disease. Fifty-seven per cent of patients undergoing surgery for aneurysmal disease and 83% of those undergoing surgery for occlusive disease noted improved urinary flow with decreased maximal urethral pressure following surgery, suggesting damage to the sympathetic nerve supply to the lower urinary tract. The improvement in urinary flow did not relate either to the assessed extent of damage to the sympathetic nerves at operation or to the type of operation or vascular anastomosis. It is concluded that aortic surgery damages the sympathetic rather than the parasympathetic nerves and that any effect on bladder function is of no serious significance.
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29
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Kirby RS, Fowler CJ, Gilpin SA, Gosling JA, Milroy EJ, Turner-Warwick RT. Bladder muscle biopsy and urethral sphincter EMG in patients with bladder dysfunction after pelvic surgery. J R Soc Med 1986; 79:270-3. [PMID: 3723519 PMCID: PMC1290310 DOI: 10.1177/014107688607900505] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Eleven patients who suffered persistent bladder dysfunction after pelvic surgery have been investigated by needle urethral sphincter electromyography (EMG) and bladder muscle biopsy, and the results compared with those obtained in a series of controls. Individual motor units recorded from the urethral sphincter in patients who had undergone pelvic surgery were strikingly abnormal, suggesting the presence of reinnervation, and the density of detrusor innervation was significantly reduced. However, since reduction in the density of detrusor innervation may occur in circumstances other than peripheral nerve injury, we conclude that urethral sphincter EMG provides the most effective means of assessing damage to vesico-urethral innervation as a result of previous pelvic surgery.
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30
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Danzi M, Ferulano GP, Abate S, Dilillo S, Califano G. Survival and locations of recurrence following abdomino-perineal resection for rectal cancer. J Surg Oncol 1986; 31:235-9. [PMID: 3724178 DOI: 10.1002/jso.2930310403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Records of 134 patients treated by abdomino-perineal resection (1971-1979) were reviewed. One hundred and thirteen had curative operations. Mortality was 2.6% and morbidity was 51%. Ninety-three were evaluable and were followed for 5 to 8 years; they were evaluated for survival and pattern of recurrence. Five-year survival for Dukes' A, B, C, and D lesions was 86, 62, 31, and 0%, respectively. Thirty-seven had recurrence: Four pelvic, nine pelvic and distant, and 24 only distant lesions. The overall incidence of failures was 47%, failure rates by stage were 11% for stage A, 27% for B, 48% for C, and 70% for D. Incidence of local recurrence was significantly higher in stage C compared to stage B. Irrespective of stage, after detection of local or distant recurrence, survival did not differ. Furthermore, radiotherapy for local recurrence and chemotherapy for distant lesions did not improve survival time.
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31
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Abstract
Bladder function and sexual potency were studied before and after surgery for rectal carcinoma. Urinary voiding after postoperative removal of indwelling catheter was impaired in seven of 22 men, leading to prostatic surgery in four. Two years later, eight of 16 men reported disturbed voiding, but no significant changes were found in bladder capacity, residual volume, flow rate, or detrusor pressure. Sexual potency was reduced in five of ten men, in one with retrograde ejaculation; and three did not achieve erection. Objective postoperative bladder disturbance was surprisingly rare. Symptoms of denervation were more commonly attributable to sympathetic rather than parasympathetic lesions, possibly as a result of more energetic dissection in the anteroposterior plane than along the lateral pelvic walls. No patient had total autonomic denervation. Wide indications are advocated for prostatic resection in patients who have prostatic symptoms in association with surgery for rectal carcinoma.
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32
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Tomoda H, Furusawa M. Sexual and urinary dysfunction following surgery for sigmoid colon cancer. THE JAPANESE JOURNAL OF SURGERY 1985; 15:355-60. [PMID: 4079142 DOI: 10.1007/bf02469930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We investigated sexual and urinary dysfunction following surgery for sigmoid colon cancer. Thirteen (46.4 per cent) of the 28 male patients with a normal sexual life prior to surgery could no longer ejaculate, but all could maintain erection. With the extension of lymph node dissection, the incidence of a disappearance of ejaculation tended to increase. In particular, in patients undergoing an extended lymph node dissection, the incidence was 53.8 per cent. Urinary dysfunction occurred in 7 (10.3 per cent) of the 68 patients (37 men and 31 women), but was slight to mild. There were no significant differences between the extent of lymph node dissection and urinary dysfunction. In surgery for sigmoid colon cancer, care should be taken to preserve the hypogastric nerves.
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33
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Abstract
One hundred ten patients at the UCLA Medical Center underwent abdominal resection from 1974 to 1980. The following effects on the urinary tract are discussed: surgical complications, anatomic changes, and functional complications. Urologic investigation and management of incontinence will be presented.
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34
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35
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Abstract
Management of vesicourethral dysfunction after a major extirpative pelvic visceral operation could be complex and difficult owing to the variety of partial and complete functional and anatomical derangements produced by the primary operation. We report our experience with 22 patients who suffered various types of vesicourethral dysfunctions after extirpative pelvic visceral surgery, 5 of whom had preoperative studies. The surgical procedures were abdominoperineal resection in 9 patients, proctocolectomy in 3, anterior resection of the rectum in 2 and radical hysterectomy in 8. All 22 patients underwent urodynamic evaluations. The abnormalities noted on the preoperative urodynamic evaluations in patients about to undergo extirpative pelvic visceral surgery suggest the need for routine preoperative assessment of the lower urinary tract for an accurate understanding of the postoperative changes.
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36
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Williams NS. The rationale for preservation of the anal sphincter in patients with low rectal cancer. Br J Surg 1984; 71:575-81. [PMID: 6378308 DOI: 10.1002/bjs.1800710802] [Citation(s) in RCA: 147] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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37
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Abstract
In a retrospective study, sexual and urologic dysfunction were evaluated after a personal interview with 110 patients operated upon for carcinoma of the rectum with a long observation period. Following abdominoperineal resection in 93 patients, sexual dysfunction was found in 32 per cent, and 18 per cent were totally impotent. In 17 patients who had low anterior resections, none became totally impotent, but six patients had reduced potency or no ejaculation. No relation was found between age, tumor classification, size and localization, or perineal wound infection and postoperative sexual dysfunction. Potency was usually regained within two years. One-third of the patients had experienced urologic symptoms following abdominoperineal resection. Sixteen per cent had minor symptoms at follow-up. Patients were not evaluated by cystometry. No correlation was found between postoperative sexual dysfunction and urologic problems.
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38
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Chang PL, Fan HA. Urodynamic studies before and/or after abdominoperineal resection of the rectum for carcinoma. J Urol 1983; 130:948-51. [PMID: 6632107 DOI: 10.1016/s0022-5347(17)51589-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Urodynamic studies were performed on 62 patients who underwent abdominoperineal resection of the rectum during the last 14 months. Of these patients 20 were evaluated preoperatively and postoperatively, and 42 were studied postoperatively only. Urodynamic studies consisted of cystometry, urethral sphincter electromyography and uroflowmetry. The results of these studies revealed a significant decrease in effective bladder capacity, and increases in first sensation to void and residual urine postoperatively. The peak and average urinary flow rates also were decreased significantly. No significant changes could be found in urethral sphincter electromyography. The incidence of complete denervation of the bladder in our study was 11.3 per cent. More severe voiding dysfunction was found in patients with stage C2 anorectal tumors than in those with stage B2 disease and in patients with tumors 4 to 8 cm. from the anal verge. Urodynamic evaluation, especially cystometry, is necessary after abdominoperineal resection to detect voiding dysfunction.
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Watters GR, Bokey EL, Chapuis PH, Maher PW, Pheils MT. Urological complications following abdominoperineal excision of the rectum for carcinoma. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1983; 53:445-7. [PMID: 6579955 DOI: 10.1111/j.1445-2197.1983.tb02482.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A retrospective study was made of 122 patients who had an abdominoperineal excision (APE) of the rectum for carcinoma at Concord Hospital between 1971 and 1979. Fifty-two percent of patients suffered one or more significant urological complications. These included urinary tract infection (32%), operative trauma to the urinary tract (8.5%) and temporary or permanent bladder dysfunction in 35% of patients. Acute urinary retention, when temporary, was managed by simple measures. Chronic retention, incontinence and some episodes of acute retention were due to a neurogenic bladder. These patients were difficult to treat. It is recommended that urodynamic studies be used to assess these patients who develop a neurogenic bladder before any treatment is instituted. This is relevant especially in those patients in whom a transurethral resection of either the bladder neck or prostate is contemplated.
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40
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Abstract
The hospital and office records of 86 patients who underwent proctectomy for cancer of inflammatory bowel disease with primary closure of the perineal wound were reviewed. Almost one fourth of all patients suffered a significant perineal wound complication, the majority of which were infections. The incidence of postoperative perineal wound complications was comparable in both groups of patients. Urinary retention occurred in 24 percent of patients who underwent abdominoperineal resection or rectal cancer, and half of these patients required transurethral resection which indicates the need for more thorough preoperative assessment of bladder function, especially in older men. The development of leg ischemia that resulted in amputation in two elderly patients who had preoperative evidence of obstructive peripheral vascular disease suggests that a synchronous two-team abdominoperineal resection with the patient in the modified lithotomy position for a prolonged period should be avoided. One third of all patients were discharged less than 10 days after surgery and two thirds within 2 weeks. Prolonged stays were more frequent in cancer patients and appeared to be related to age rather than to the development of postoperative complications. The perineal wound after abdominoperineal resection for cancer healed more rapidly and more completely than did the wound after proctectomy for inflammatory bowel disease. Fourteen percent of the inflammatory bowel disease patients did not have a healed wound 1 year after surgery. The extent of rectal cancer as determined by Duke's classification played no role in healing of the perineal wound, but women with rectal cancer healed at a slower rate than did men. The location of the exit site for wound catheters and the use of cautery and preoperative steroid therapy appeared too have no effect on the healing of the perineal wound.
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41
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Abstract
A total of 13 men underwent synchronous video/pressure/flow electromyography studies after abdominoperineal resection of the rectum. All patients had diminished pressure in the proximal urethra and an incompetent vesical neck suggestive of sympathetic denervation. Five patients (38 per cent) had cystometric evidence of parasympathetic denervation and 7 (54 per cent) had electromyographic evidence of pudendal denervation. These data suggest that denervation owing to surgical injury is an important cause of persistent symptoms after abdominoperineal resection of the rectum.
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42
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43
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Mundy AR. An anatomical explanation for bladder dysfunction following rectal and uterine surgery. BRITISH JOURNAL OF UROLOGY 1982; 54:501-4. [PMID: 7171956 DOI: 10.1111/j.1464-410x.1982.tb13575.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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44
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Fryjordet A. Bladder function following rectal resections. Int Urol Nephrol 1982; 14:275-7. [PMID: 7161010 DOI: 10.1007/bf02081813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Fifteen patients with urinary retention following rectal resection were examined urodynamically, including cystometry and simultaneous measurement of flow and pressure in the bladder and in the abdomen. Five patients suffered from bladder neck obstruction. This was in most cases put down to a preexisting prostatic enlargement. In 4 patients it was impossible to detect any function of the bladder muscle. Detrusor insufficiency was the cause of retention in the remaining 6 patients.
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45
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Neal DE, Parker AJ, Williams NS, Johnston D. The long term effects of proctectomy on bladder function in patients with inflammatory bowel disease. Br J Surg 1982; 69:349-52. [PMID: 7082965 DOI: 10.1002/bjs.1800690621] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The effect on bladder function of protectomy for colitis or Crohn's disease was studied by means of a questionnaire and by pressure/flow cystometry. Thirty-seven patients who had undergone protectomy for inflammatory bowel disease were compared with 34 control patients who had undergone bowel resection without protectomy. Symptoms of urinary dysfunction were found to be significantly more common in patients after protectomy than in controls (P less than 0.05). Straining at micturition (P less than 0.05) and a sensation of incomplete emptying of the bladder (P less than 0.02), in particular, were significantly more common after protectomy. Evidence of denervation of the bladder, as shown by the finding of capacious bladders with poor detrusor function, was found in 6 patients after protectomy but in none of the controls (P less than 0.05). The residual volume of urine in the bladder after micturition was significantly greater in patients after protectomy than in controls (P less than 0.02). Thus, the bladder is at risk of denervation in the course of protectomy for inflammatory bowel disease even when dissection is kept close to the rectum.
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46
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Neal DE, Williams NS, Johnston D. A prospective study of bladder function before and after sphincter-saving resections for low carcinoma of the rectum. BRITISH JOURNAL OF UROLOGY 1981; 53:558-64. [PMID: 7317742 DOI: 10.1111/j.1464-410x.1981.tb03260.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The effects of sphincter-saving resections for carcinoma of the rectum on bladder function were studied prospectively. Twenty-seven patients, each acting as his or her own control, were studied before, shortly after and 9 months after operation by means of pressure/flow filling and voiding cystometry. After operation there was a significant and lasting increase in the residual volume of urine and a temporary decrease in the compliance of the bladder. There was a statistically significant decrease in detrusor contraction pressure after operation, which persisted throughout the period of study. This was probably due to partial denervation of the bladder. Four patients had signs of total or almost total denervation of the bladder. There was a significant correlation between proximity of the tumour to the anal verge and risk of damage to the nerve supply to the bladder. Thus sphincter-saving resections of the rectum for carcinoma are associated with a significant risk of bladder denervation. Many of the "minor" symptoms of bladder dysfunction which develop after this procedure are due to partial denervation of the bladder.
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47
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Kirkegaard P, Hjortrup A, Sanders S. Bladder dysfunction after low anterior resection for mid-rectal cancer. Am J Surg 1981; 141:266-8. [PMID: 7457746 DOI: 10.1016/0002-9610(81)90171-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Twenty consecutive patients with carcinoma 7 to 12 cm from the anus underwent radical low anterior resection of the rectum; the anastomosis was performed by the EEA stapling instrument. One patient died from pulmonary complications. On urologic follow-up 6 to 8 months after the operation, five patients had significant symptoms from the urinary tract, and in three patients denervation of the bladder was demonstrated. The study establishes that bladder paresis, which is a well-known complication after extirpation of the rectum, also may follow very low anterior resection with anastomosis. The importance of careful follow-up is emphasized
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48
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Gerstenberg TC, Nielsen ML, Clausen S, Blaabjerg J, Lindenberg J. Bladder function after abdominoperineal resection of the rectum for anorectal cancer. Urodynamic investigation before and after operative in a consecutive series. Ann Surg 1980; 191:81-6. [PMID: 7352782 PMCID: PMC1344623 DOI: 10.1097/00000658-198001000-00016] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In a consecutive series of 26 patients (10 men and 16 women) undergoing abdominoperineal resection of the rectum, cystometry and pressure-flow-EMG measurements were made preoperatively and three and 6-12 months after operation. Two patients developed neurogenic bladder paresis (7.7%, 95% c.l. 1-25%). Men with even slight complaints of bladder outlet obstruction preoperatively ran a risk of postoperative aggravation demanding surgery. In women no significant changes in micturition patterns were found. It is concluded that urinary flow measurement and cystometry should be available as minimum screening procedures after abdominoperineal resection of the rectum to detect bladder dysfunction at an early stage.
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Ackerman NB, Lynch S, Marbarger P, Patil UB. Improved exposure for excision of rectal carcinomas: initial experiences with a pubic resection technique. Ann Surg 1979; 190:543-8. [PMID: 485621 PMCID: PMC1344525 DOI: 10.1097/00000658-197910000-00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Preliminary experiences with a transpubic approach for carcinoma of the rectum are described. By excising a wedge of pubic bone and freeing the left lateral attachments of the bladder, the entire length of rectum can be exposed, down to the level of the levator muscles. Dissection of the tumor can be performed under direct vision, even in unfavorable anatomic and pathologic situations. Low rectal anastomoses, at levels of 1--2 cm above the anus, may be performed with greater ease. It is felt that urinary problems should be uncommon and that orthopedic complications should not occur since sacroiliac articulations are not disturbed by retraction.
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