BERKELEY, CA (UroToday Inc.) - Voiding and sexual dysfunction after deep rectal resection has been described with various frequencies in the literature. The dysfunction is thought to occur secondary to a neurological insult during the resection. P. Sterk and colleagues from Kempten, Germany performed a prospective study to evaluate the baseline preoperative voiding and sexual function in a cohort of patients undergoing deep resection with mesorectal excision in order to determine any pre-existing abnormalities. Post-operatively, the incidence of voiding and sexual function was determined, and data was examined to observe if there was a time-dependent change of dysfunction. Results were also analyzed to see whether there was a relationship between postoperative urological dysfunction and the patient's age. The study is published in the April, 2005 issue of the International Journal of Colorectal Disease.

The study group comprised 52 patients (36 men and 16 women) with a primary rectal carcinoma who underwent deep resection with mesorectal excision. Patients were assessed pre-operatively with a urological evaluation which consisted of a careful voiding and sexual history, uroflowmetry and a sonographic residual urine determination. A detailed sexual history was also obtained through use of a questionnaire. Patients were examined and their voiding and sexual functions were assessed again at 3 and 6 months post-operatively.

Analysis showed that 49 of the 52 patients had no preoperative voiding dysfunction, while the remaining three patients had post-void residuals (PVR's) over 100 ml. Post-operatively, 12 of the 49 patients with normal preoperative urinary function had voiding dysfunction, but only four of the male patients had elevated PVR's in the third postoperative month. Therefore, only 10% suffered from vesical denervation after 6 months. There was no relationship between a patient's age and this dysfunction although the small sample size may have not allowed this difference to be elucidated.

The assessment of preoperative sexual dysfunction revealed that 36 of the 52 patients (seven women and 29 men) were potent and had regular sexual intercourse. Eleven men specified a reduced or limited erection but all had occasional intercourse. One of the potent men experienced no ejaculation preoperatively. Postoperatively, 8 of the 29 men were impotent and two of the 29 men had retrograde ejaculation. Therefore, 30% of the preoperatively potent men had sexual dysfunction postoperatively. There was no correlation between postoperative impotence and the age of the patient at the time of surgery although it is likely that potency may diminish with advanced age.

The results of this study underline the importance of risk estimation for possible postoperative voiding and sexual dysfunction in this patient group. Of the patients with postoperative bladder dysfunction, 90% improved within 6 months after surgery but 10% had irreversible nerve damage, and this data should not be withheld from the patient at the time of preoperative discussion.

Int J Colorectal Dis. 2005 Apr 22