Chirurgie du cancer

Abstrait

Impact of Total Mesorectal Excision on Bladder and Sexual Function in Rectal Cancer

Mohammad Sultan Dar, Fazl Qadir Parray*, Arif Hamid Bhat, Nisar Ahmed Chowdri, and Mohd Lateef Wani

Background: In this prospective study we evaluated bladder, sexual function and frequency of identification of pelvic autonomic nerve preservation (PANP) after open total mesorectal excision in males with operable carcinoma rectum below 12 cm.

Patients and Methods: prospective study of 47 male patients of carcinoma rectum 4-12 centimetres from anal verge. The preoperative status was used for comparison with the post-operative and follow up status of same patient. Sexual function was assessed by international index of erectile function questionnaires (IIEF) and bladder function was assessed by uroflowmetry, transcutaneous ultrasound and international prostate symptom score (IPSS).

Results: IIEF score decreased at 1month post operation with significant change in p-value and at 3 month with an insignificant change in P-value. After 3 months sexual dysfunction was reported in 30% patients. Erectile function was also significantly decreased at 1 month and at 3 months it was seen in 37% of patients. Change in IPSS was significant at 1month and resultant bladder function was present in 90% of patients and at 3 months present in 28% of patients. Resultant bladder dysfunction with USG was 82% and 30% after 1 and 3 months of surgery respectively. With urodynamics resultant bladder dysfunction was present in 77% and 29% of patients respectively after 1 and 3 months of surgery. Pelvic autonomic nerves were identified in 96% patients and complete preservation of nerves was achieved in 89% patients and partial preservation was achieved 6% and in 4% pelvic autonomic nerves could not be identified.

Conclusion: Bladder and sexual dysfunction can be decreased after an meticulous nerve sparing total mesorectal excision. IIEF and IPSS are all well suited to evaluate bladder and sexual dysfunction after rectal surgery.