PURPOSE: Total mesorectal excision with pelvic autonomic nerve preservation has been reported to be an optimal surgery for rectal cancer. It minimizes local recurrence and sexual and urinary dysfunction. The aim of this study was to assess the safety of total mesorectal excision with pelvic autonomic nerve preservation in terms of voiding and sexual function in males with rectal cancer. METHODS: We performed urine flowmetry using Urodyn® and a standard questionnaire using the International Index of Erectile Function and the International Prostate Symptom Score before and after surgery in 68 males with rectal cancer. RESULTS: Significant differences in mean maximal urinary flow rate and voided volume were seen before and after surgery (18.9 ± 5.7 vs. 13.7 ± 7.0, 240 ± 91.9 vs. 143 ± 78; P < 0.05, P < 0.05, respectively), but no differences in residual volume before and after surgery were apparent (4.4 ± 2.6 vs. 8.1 ± 4.4; P > 0.05). The total International Prostate Symptom Score was increased after surgery from 6.2 ± 5.8 to 9.8 ± 5.9 (P < 0.05). There were no changes of score for one of each of seven International Prostate Symptom Score items in 49 patients (73.5 percent) to 61 patients (89.7 percent). Five International Index of Erectile Function domain scores (erectile function, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction) were significantly decreased after surgery (18.2 ± 9.3 vs. 13.5 ± 9, 8.4 ± 4.2 vs. 4.4 ± 2.9, 5.8 ± 2.9 vs. 4.4 ± 2.9, 6.1 ± 2.4 vs. 4.8 ± 2, 6.1 ± 2.2 vs. 4.5 ± 2.3, respectively; P < 0.05). Erection was possible in 55 patients (80.9 percent); penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in three patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). International Index of Erectile Function domains such as sexual desire and overall satisfaction were greatly decreased in 39 patients (57.4 percent) and 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that age older than 60 years (sexual desire, P = 0.019), within six months (erectile function, P = 0.04; intercourse satisfaction, P = 0.011; orgasmic function, P = 0.03), lower rectal cancer (erectile function, P = 0.02; intercourse satisfaction, P = 0.036; orgasmic function, P = 0.027) were significant factors adversely affecting sexual function. CONCLUSION: Total mesorectal excision with pelvic autonomic nerve preservation showed relative safety in preserving sexual and voiding function. The International Prostate Symptom Score and International Index of Erectile Function questionnaires were useful in assessing urinary and sexual function.
Bibliographical noteFunding Information:
Supported in part by a grant from the Brain Korea 21 Project for Medical Science Read at the meeting of The American Society of Colon and Rectal Surgeons, San Diego, California, June 2 to 7, 2001. Address reprint requests to Dr. Kim: Department of Surgery, Yonsei University College of Medicine, Seodaemun-Gu Shinchondong 134, CPO 8044, Seoul, Korea.
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