Abstract
BackgroundSexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests.MethodsWe studied a group of 57 patients submitted to rectal resection for adenocarcinoma. All the patients underwent neurological, psychological and the following neurophysiological tests: sacral reflex (SR), pudendal somatosensory evoked potentials (PEPs), motor evoked potential (MEPs) and sympathetic skin responses (SSRs). The results were compared with a control group of 67 rectal cancer patients studied before surgery. Only 10 of these patients could be studied both pre- and postoperatively. 10 patients submitted to high dose preoperative chemoradiation were studied to evaluate the effect of this treatment on sexual function. Statistical analysis was performed by means of the two-tailed Student's t test for paired observations and k concordance test.Results59.6% of patients operated reported sexual dysfunction, while this symptom occurred in 16.4% in the control group. Moreover, a significantly higher rate of alterations of the neurophysiological tests and longer mean latencies of the SR, PEPs, MEPs and SSRs were observed in the patients who had undergone resection. In the 10 patients studied both pre and post-surgery impotence occurred in 6 of them and the mean latencies of SSRs were longer after operation. In the 10 patients studied pre and post chemoradiation impotence occurred in 1 patient only, showing the mild effect of these treatments on sexual function.ConclusionPatients operated showed severe sexual dysfunctions. The neurophysiological test may be a useful tool to investigate this complication. The neurological damage could be monitored to decide the rehabilitation strategy.
Highlights
Sexual dysfunction following surgery for rectal cancer may be frequent and often severe
In the control group this complication occurred in only 16.4% (p ≤ 0.0001)
Abnormal values were observed in 33.3% of the patients submitted to the sacral reflex (SR) test (p = 0.05), in 21.7% of the patients submitted to pudendal somatosensory evoked potentials (PEPs), in 33.3% of the patients submitted to motor evoked potentials (MEPs) and in 71.4% of the patients submitted to sympathetic skin responses (SSRs) (p ≤ 0.03), showing a higher incidence of alterations than in the control group
Summary
Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. Sexual dysfunction following surgery for rectal cancer is variable and the literature of the past reported rate until 100% of the patients. The explanation is a damage of the pelvic autonomic nerves with consequence on sexual functioning in males and females (erection, ejaculation, drive). Neurophysiological techniques such as electromyography of the pelvic floor, examination of the sacral reflex (SR), pudendal somatosensory evoked potentials (PEPs), motor evoked potentials (MEPs) and sympathetic skin responses (SSRs), have been employed in recent years to evaluate this complication [10-12]. The patients underwent psychological tests (psychodynamic interview, Hospital Anxiety and Depression Scale of Zigmond and Snaith) [14] Those with psychogenic impotence, sexual psychological dysfunctions and other psychiatric symptoms were excluded from the study
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