Postoperative Urinary Dysfunction Research Articles

Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery

Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery

Intermittent catheter clamping combined with active urination training (ICCAUT) to reduce the risk of urinary dysfunction in patients after proctectomy: a single-center cohort study.

Intermittent urethral catheter clamping is widely used to reduce secondary catheterization in patients after proctectomy; however, its effectiveness is unclear. This study investigated the effects of intermittent catheter clamping combined with active urination training (ICCAUT) on postoperative urinary dysfunction in patients after proctectomy. This retrospective cohort study analyzed data on patients who underwent laparoscopic/robotic-assisted proctectomy at a single medical center in China between July 2023 and January 2024. Patients received ICCAUT or free urinary drainage during the indwelling urethral catheter period after surgery. Data from the ICCAUT and free-drainage groups were compared. The primary outcome measure was urinary dysfunction. The secondary outcomes were urinary tract infections, time to first void after catheter removal, and urine volume during first voiding. Propensity-score matching (PSM), inverse probability-of-treatment weighting (IPTW), and multivariable logistic regression analyses were used to identify factors associated with urinary dysfunction. Among 360 eligible patients, 173 received a free-drainage strategy and 187 received ICCAUT. The incidence of urinary dysfunction was 52.5% overall and was significantly lower in the ICCAUT group than in the free-drainage group (45.1% vs. 59.4%; p = 0.009). The lower incidence of urinary dysfunction in the ICCAUT group was confirmed in the PSM (44.7% vs. 59.3%; p = 0.03) and IPTW (44.5% vs. 57.1%; p = 0.028) analyses. Multivariable logistic regression analysis revealed that ICCAUT was independently associated with a lower risk of urinary dysfunction (OR, 0.55; 95% CI, 0.34-0.89; p = 0.015). Subgroup analysis found that, compared with female patients, male patients are more likely to benefit from the ICCAUT strategy (p for interaction = 0.029; adjusted OR, 0.33; 95% CI, 0.17-0.62; p < 0.001). The ICCAUT strategy did not significantly increase the risk of urinary tract infection (p = 0.349). The ICCAUT strategy may benefit the recovery of urinary function after proctectomy, especially for male patients. ICCAUT showed an independent association with a lower risk of urinary dysfunction and UTI, with urinary tract infection comparable to that of the free-drainage strategy.

Effect of kegel pelvic floor muscle exercise on improving urinary disorder in rectum cancer patients after rectal surgery: a randomized clinical trial.

Postoperative urinary dysfunction poses a significant challenge for rectal cancer patients. While pelvic floor muscle training (PFMT) has shown promise in other contexts, its efficacy following rectal cancer surgery remains uncertain. A clinical trial involving 79 rectal cancer patients found that initiating Kegel exercises post-surgery led to significant improvements in urinary symptoms compared to standard care. Adherence to exercises correlated with symptom reduction, with no reported adverse events. We have defined the main outcome of our study as the improvement in urinary function scores post-surgery. Effectiveness is considered as any statistically significant improvement in these scores. Early initiation of Kegel exercises shows promise in alleviating postoperative urinary dysfunction in rectal cancer patients. Further research is needed to optimize postoperative care protocols and enhance patient outcomes.

Transperineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer could improve short-term outcomes: A single-institution retrospective cohort study.

Transperineal minimally invasive surgery (TpMIS) during laparoscopic abdominoperineal resection (APR) is an emerging approach that allows for the precise treatment of lower rectal cancer. However, evidence regarding the efficacy of TpMIS is insufficient. This study evaluated the efficacy of TpMIS during laparoscopic APR for patients with lower rectal cancer. Patients who underwent laparoscopic APR with TpMIS (TpMIS group; n = 12) and those who underwent conventional laparoscopic APR for low rectal cancer (conventional group; n = 13) were enrolled consecutively in this retrospective study. Standardized TpMIS was performed at our institution. Patient and tumor characteristics and intraoperative, postoperative, and pathological outcomes were compared between groups. The primary outcome was postoperative perineal wound infection. No patients in the TpMIS group experienced postoperative perineal wound infection; however, five (38.5%) patients in the conventional group experienced postoperative perineal wound infection (significant difference; p = 0.016). The estimated blood loss (median, 81mL vs. 463mL) and incidence of postoperative urinary dysfunction (8.3% vs. 46.1%) were significantly lower in the TpMIS group than in the conventional group. The postoperative hospital stay (median, 13 vs. 20days) of the TpMIS group was significantly shorter than that of the conventional group. Pathological outcomes did not differ between groups. The positive circumferential resection margin rates of the TpMIS and conventional groups were 8.3% and 15.4%, respectively. TpMIS during laparoscopic APR was associated with significant improvements in the postoperative outcomes of patients with low rectal cancer.

Advantages of robotic surgery for rectal cancer compared to laparoscopic surgery: pelvic anatomy and its impact on urinary dysfunction.

The anatomical dimensions and the shape of the pelvis influence surgical difficulty for rectal cancer. Compared to conventional laparoscopic surgery, robot-assisted surgery is expected to improve surgical outcomes due to the multi-joint movement of its surgical instruments. The aim of this study was to investigate the impact of pelvic anatomical indicators on short-term outcomes of patients with rectal cancer. A retrospective analysis was conducted using data from 129 patients with rectal cancer who underwent conventional laparoscopic low anterior resection (L-LAR) or robot-assisted low anterior resection (R-LAR) with total mesorectal excision or tumor-specific mesorectal excision between January 2014 and December 2022. The transverse diameter of the lesser pelvis and the sacral promontory angle were used as indicators of pelvic anatomy. The sacral promontory angle was not associated with age and sex while the pelvic width was smaller in male than in female. The pelvic width did not affect postoperative complications in both L-LAR and R-LAR. In contrast, postoperative urinary dysfunction occurred more frequently in patients with a small sacral promontory angle (p = 0.005) in L-LAR although there was no impact on short-term outcomes in R-LAR. Multivariate analysis demonstrated that a small sacral promontory angle was an independent predictive factor for urinary dysfunction (p = 0.032). Sharp angulation of the sacral promontory was a risk factor for UD after L-LAR. Robot-assisted surgery could overcome anatomical difficulties and reduce the incidence of UD.

The urinary tract reconstruction in a robot-assisted surgery for rectal malignancy with combined prostate and seminal vesicle resection.

In certain cases of rectal malignancy in which invasion is confined to the prostate and/or seminal vesicles, bladder-sparing surgery may be chosen instead of total pelvic exenteration. However, even if the bladder is preserved, postoperative urinary dysfunction and vesicourethral anastomotic leakage are concern. We employ various techniques based on robot-assisted radical prostatectomy for reconstructing the urinary tract. These techniques include advanced reconstruction of vesicourethral support, total anatomical reconstruction, and a method called anterior reconstruction. In addition, suture fixation of bladder to the anterior abdominal wall, and re-approximation of bladder by peritoneal suture were done. Reliable robot-assisted vesicourethral anastomosis and reinforcement of the anastomotic wall could potentially enhance the self-voiding rate and decrease the risk of anastomotic failure.

Short-term effects of suprapubic catheterization on detrusor muscle contraction in a rat model of postoperative urinary dysfunction

Catheterization is commonly performed in pelvic surgery to manage postoperative urinary dysfunction. However, little is known about the effects of catheterization on bladder function, although catheterization can drain urine from the bladder. In the present study, we evaluated the short-term effects of catheterization on detrusor muscle contraction in a rat model of postoperative urinary dysfunction due to bilateral accessory nerve injury (BACNI). Ten-week-old male Wistar/ST rats were divided into sham, sham＋catheterization (sham＋C), BACNI, and BACNI＋catherterization (BACNI＋C) groups. The sham＋C and BACNI＋C groups underwent catheter placement in the bladder dome prior to sham or BACNI surgery and intermittent bladder drainage during the observation period. Four hours after surgery, the bladders were excised and subjected to isometric tension study and immunofluorescence staining. Bladder overdistension and overflow urinary incontinence were observed in the BACNI group, not the BACNI＋C group. The contractile responses of the detrusor muscle to 80 mM KCl, carbachol, and electrical field stimulation (EFS) were enhanced in the BACNI group compared to the sham group; the enhanced contractile responses to EFS were improved in the BACNI＋C group. The ratio of the detrusor muscle layer area to the total bladder area increased with increasing interstitial area ratio in the BACNI and BACNI＋C groups, while the total bladder area increased in the sham＋C and BACNI＋C groups. These results suggest that catheterization does not improve the augmentation of detrusor muscle contraction and increase in the detrusor muscle layer area ratio immediately after BACNI and that catheterization causes bladder hypertrophy.

Surgical Anatomy and Dissection of the Hypogastric Plexus in Nerve-Sparing Radical Hysterectomy.

Radical hysterectomy is a central surgical procedure in gynecological oncology. A nerve-sparing approach is essential to minimize complications from iatrogenic injury to the pelvic nerves, resulting in postoperative urinary, anorectal, and sexual dysfunction. The hypogastric plexus (HP), a complex network of sympathetic and parasympathetic nerves, plays a critical role in pelvic autonomic innervation. This article offers a comprehensive overview of the surgical anatomy of the HP and provides a step-by-step description of HP dissection, with a particular emphasis on preserving the bladder nerve branches of the inferior HP. A thorough understanding and mastery of the anatomical and surgical nuances of HP dissection are crucial for optimizing outcomes in nerve-sparing gynecologic-oncological procedures.

Postoperative Bowel and Urinary Dysfunction of Sacrococcygeal Teratoma

Background: Teratomas are composed of multiple tissues foreign to the organ or site from which they arise. Although teratomas are sometimes defined as having three embryonic layers (endoderm, mesoderm, and ectoderm), and are generally divided into gonadal and extragonadal types. The most common extragonadal type being sacrococcygeal teratomas which constitute the most prevalent childhood germ-cell cancers.&#x0D; Objective: To assess postoperative bowel and urinary dysfunction in babies with sacrococcygeal teratomas&#x0D; Patients and Methods: 23 patients having sacrococcygeal teratomas were received at the time between May 2014 to September 2022 at the department of pediatric surgery in Raparen Teaching Hospital in Erbil city.All recorded data from case note, operation notes together with demographic data and operative details obtained and recorded . The follow-up time span was between three months to seven years.&#x0D; Results: The age range was from 1 day to 4year, (median 3 days) , Presenting features include posterior sacral mass in 17 cases (73.9%), pelviabdominal mass in 5 cases (21.7%), urinary retention in 4 cases (17.4%), palpable rectal mass in 2 cases 98.7%), intestinal obstruction in 1 case (4.3%), and constipation in 4 cases (17.4%). Eight cases (34.8%) were type I, 6 cases (26.1%) type II and III, and 3 cases (13%) were type IV. postoperative complications were wound infection in 4 patients (17.4%), constipation in 5 cases (21.7%), 1 (4.3%) ugly scar arranged for aesthetic operation, fistula 1(4.3%) case, recurrence in 1(4.3%).&#x0D; Conclusion: Patients with sacrococcygeal teratoma were more likely to experience uncontrolled urination, difficulties emptying the bladder, pyelonephritis, and constipation than healthy children. Children with big and immature teratomas had a higher prevalence of dysfunctional outcomes.

Introduction to Rectal Cancer and the Importance of Nerve Preservation

Introduction: Rectal cancer is an increasingly common and worrying disease that affects the rectum, the terminal part of the large intestine. Early detection and treatment are crucial to improving patient outcomes. Methods: We conducted a narrative review of the scientific literature to examine nerve preservation in rectal cancer surgery. Previous studies were analyzed and relevant findings related to the preservation of autonomic and pelvic nerves, as well as the prevention of sphincter dysfunction, were identified. Results: Rectal surgeries may be associated with various complications, which can have a significant impact on patients' quality of life. The preservation of the autonomic and pelvic nerves plays a crucial role in reducing postoperative urinary and sexual dysfunction. Studies have shown that nerve-sparing surgical techniques improve functional outcomes and patient satisfaction. Discussion: Nerve preservation in rectal cancer surgery requires a meticulous surgical approach and a thorough understanding of the anatomical structures involved. By preserving nerve function, not only urinary and sexual function are improved, but also overall quality of life. In addition, nerve preservation plays a critical role in preventing sphincter dysfunction after pelvic exenteration surgery. Conclusions: The preservation of autonomic and pelvic nerves in rectal cancer surgery is essential to minimize complications and improve patients' quality of life. Proper patient selection and compliance with oncology criteria contribute to the preservation of sphincter function without compromising survival rates. Preoperative radiation therapy may also increase the likelihood of sphincter sparing in patients with rectal cancer

Comparison of Anterior and Posterior Approach Bilateral Sacrospinous Ligament Fixation for Vaginal Vault Prolapse

Background: We aimed to investigate the outcomes of anterior and posterior approaches in patients who underwent sacrospinous ligament fixation for apical prolapse. Methods: The study included hysterectomized women with grade ≥2 apical prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who presented to our center between 2019 and 2022. Out of the 48 patients included in the study, 24 underwent posterior bilateral sacrospinous ligament fixation (PB-SSLF), while the other 24 underwent anterior bilateral sacrospinous ligament fixation (AB-SSLF). Postoperative anatomical recurrence of anterior vaginal wall prolapse, according to the POP-Q system, was defined as follows: cystocele ≥ stage II (Aa or Ba ≥–1 cm), recurrent apical prolapse ≥ stage II (C ≥–1 cm), and posterior vaginal wall prolapse ≥ stage II (Ap or Bp ≥–1 cm). Postoperative follow-up visits were scheduled routinely at 1, 3, 6, and 12 months after the operation, and then annually. Complications were recorded according to the Clavien-Dindo classification. Rates in the groups were compared using the Chi-square test. Independent two-group comparisons of numerical variables were performed using the Student t-test when the normal distribution assumption was met and the Mann-Whitney U test when the assumption was not met. The significance level (alpha) was set at p &lt; 0.05. Results: No significant difference was observed in terms of postoperative anterior recurrence between the groups that underwent bilateral anterior and posterior SSLF (16.7% each). Regarding the operation durations, the group that underwent AB-SSLF had longer operation times compared to the group that underwent PB-SSLF (80 minutes and 42.5 minutes, respectively). A higher incidence of postoperative urinary dysfunction was observed in patients who underwent anterior bilateral sacrospinous ligament fixation (p = 0.012). No grade 3b or higher complications were observed according to the Clavien-Dindo classification. Conclusions: AB-SSLF is an effective method in the surgical treatment of apical and anterior pelvic prolapse. However, the anterior compartment failure rate is still a limitation. Further research is required to investigate its long-term efficacy.

Technical aspects of a new approach to intraoperative pelvic neuromonitoring during robotic rectal surgery

It has been found that rectal surgery still leads to high rates of postoperative urinary, fecal, or sexual dysfunction, which is why nerve-sparing surgery has gained increasing importance. To improve functional outcomes, techniques to preserve pelvic autonomic nerves by identifying anatomic landmarks and implementing intraoperative neuromonitoring methods have been investigated. The objective of this study was to transfer a new approach to intraoperative pelvic neuromonitoring based on bioimpedance measurement to a clinical setting. Thirty patients (16 male, 14 female) involved in a prospective clinical investigation (German Clinical Trials Register DRKS00017437, date of first registration 31/03/2020) underwent nerve-sparing rectal surgery using a new approach to intraoperative pelvic neuromonitoring based on direct nerve stimulation and impedance measurement on target organs. Clinical feasibility of the method was outlined in 93.3% of the cases. Smooth muscle contraction of the urinary bladder and/ or the rectum in response to direct stimulation of innervating functional nerves correlated with a change in tissue impedance compared with the pre-contraction state. The mean amplitude (Amax) of positive signal responses was Amax = 3.8%, negative signal responses from a control tissue portion with no stimulation-induced impedance change had an amplitude variation of 0.4% on average. The amplitudes of positive and negative signal responses differed significantly (statistical analysis using two-sided t-test), allowing the nerves to be identified and preserved. The results indicate a reliable identification of pelvic autonomic nerves during rectal surgery.

Assessment of Risk Factors for Iatrogenic Genitourinary Injuries During a Proctectomy.

It is critical to avoid iatrogenic injuries affecting genitourinary organs in order to prevent postoperative urinary or sexual dysfunction, which lead to lengthier recovery and possibly reoperation. Using the 2016-2019 American College of Surgeons National Quality Improvement Program (ACS NSQIP) Targeted Proctectomy Database, we collated 2577 patients with non-metastatic rectal cancer who underwent a laparoscopic or open proctectomy. Univariate analysis was used to identify differences in perioperative factors and genitourinary injuries (GUIs) between operative approaches, and multivariate logistic regression was used to identify independent risk factors for sustaining an intraoperative GUI. The rates of preoperative comorbidities were significantly higher among patients who received an open operation. The proportion of GUIs was also significantly higher in this patient population. Multivariate logistic regression demonstrated that patients who underwent a laparoscopic proctectomy were associated with a 51.4% lower risk of sustaining a GUI. Furthermore, >10% body weight loss in the past 6 months and ASA class 3 status were independently associated with a higher risk of GUI regardless of operation type. Patients who undergo a laparoscopic proctectomy are associated with a lower risk of GUI. On the other hand, patients with >10% body weight loss and ASA class 3: Severe Systemic Disease were associated with a higher risk of GUI.

Motor-evoked potential monitoring from urinary sphincter muscle during pediatric untethering surgery: a case series.

Postoperative urinary dysfunction following untethering surgery for spinal lipoma is devastating. To assess urinary function, we invented a pediatric urinary catheter equipped with electrodes for the direct transurethral recording of myogenic potential from the external urethral sphincter (EUS). This paper presents two cases in which urinary function was monitored intraoperatively by recording of motor-evoked potential (MEP) from EUS during untethering surgery in children. Two children (aged 2 and 6years) were included in this study. One patient had no preoperative neurological dysfunction, while the other had frequent urination and urinary incontinence. A pair of surface electrodes was attached to a silicone rubber urethral catheter (6 or 8 Fr; diameter, 2 or 2.6mm). The MEP from the EUS was recorded to assess the function of the centrifugal tract from the motor cortex to the pudendal nerve. Baseline MEP waveforms from the EUS were successfully recorded with latency and amplitude of 39.5ms and 66µV in patient 1 and 39.0ms and 113µV in patient 2, respectively. A significant decrease in amplitude was not observed during surgery in the two cases. No new urinary dysfunction and complications associated with the urinary catheter-equipped electrodes developed postoperatively. Using an electrode-equipped urinary catheter, monitoring of MEP from the EUS could be applicable during untethering surgery in pediatric patients.

Post-operative Urinary Dysfunction Following Shoulder Surgery: Rates and Risk Factors.

Post-operative urinary retention (POUR) and dysfunction are recognized complications following orthopaedic surgery. Recent literature has focused on urinary retention and its associated complications following hip and knee reconstruction and lower extremity surgery. There is a paucity of literature focusing on POUR and shoulder surgery. The purpose of this study is to describe the rates of urinary dysfunction in patients undergoing shoulder surgery as well as the associated risk factors. This was a single institution, prospective cohort study. Eligibility criteria included patients older than 50 years of age undergoing open or arthroscopic shoulder surgery. The primary outcome was the American Urological Association (AUA) symptom score (7 questions total scored 0-5, total 35 points max) administered before and after surgery. Higher scores reflect worse urinary dysfunction. Intra-operative data such as type of surgery, type of anesthesia, use of anticholinergics, peripheral nerve block, length of case, and amount of intravenous fluids were collected. Of 194 patients, the mean age was 61.4 years (Standard Deviation (S.D.) = 13.0)) and the average BMI was 29.2 (S.D. = 5.6). The sample was 35.6% female. Overall, 46.4% reported worse AUA scores post-operatively within the first 3 to 5 days, including 4.1% of which were clinically defined as "moderately worse" (>5 point worse) or "much worse" (>11 points worse). Worse preoperative AUA scores correlated with worse postop AUA score on linear regression analysis (r=0.883, P<0.0001). Males with a history of BPH showed a statistically significant positive association with worsening urinary dysfunction postoperatively (P=0.039). Four patients (2.1%) required postoperative catheterization. A significantly higher percentage of patients with preoperative AUA scores of ≥11 experienced worsening of urinary function post-operatively (P=0.04). Worsening of urinary function following shoulder surgery is common. The AUA score may be used to identify at-risk patients and to track changes in urinary function post-operatively. Men with a diagnosis of BPH are at particularly high risk. Further investigation is needed to elucidate the impact of urinary dysfunction on patient outcomes, satisfaction, and cost as well as the role of prophylactic medications.

8772 The Impact of Acute Urinary Retention Volume on Postoperative Urinary Dysfunction Following Robotic Sacrocolpopexy

<h3>Study Objective</h3> Sacrocolpopexy (SCP) for pelvic organ prolapse is typically performed with a midurethral sling (MUS) to treat or prevent postoperative stress urinary incontinence (SUI). A known complication is the development of postoperative urinary dysfunction, namely obstructed voiding, chronic urinary retention (CUR) and eventual sling release. This study aims to investigate whether the degree of acute urinary retention (AUR) is predictive of longer-term sequelae. <h3>Design</h3> Retrospective case control study. <h3>Setting</h3> Academic-affiliated community hospital. <h3>Patients or Participants</h3> All patients (n=708) undergoing a robotic SCP with transobturator MUS placement by a single urogynecologist between January 2012 and March 2022 stratified by their post-void residual bladder volumes (PVRBV) were included in this study. <h3>Interventions</h3> Patients were grouped by their degree of PVRBV: ≤150mL (n=397), >150 and ≤300mL (n=111), >300 and ≤450mL (n=84), and >450mL (n=116). <h3>Measurements and Main Results</h3> Higher volumes of AUR had a statistically significant increase in the percentage chance risk of CUR. (6.3%, 16.2%, 10.7%, 14.7%, p<0.05). A non-statistically significant distribution was observed between PVRBV and requirement for eventual sling release (3%, 1.8%, 0%, 6%, p=0.08). There were no differences in other long term postoperative sequelae amongst variable degrees of acute PVRBV including urinary symptoms, need for postoperative medications or return to the emergency department or hospital readmissions. Patients with greater PVR volumes had lower body mass index (28.7, 27.7, 27.2, 26.8 kg/m², p<0.05). Other demographic variables were similar amongst groups. <h3>Conclusion</h3> Increasing BMI has a protective effect from developing CUR. Higher PVRBV in excess of 150mL were associated with a greater propensity for CUR. This had a trend toward requiring sling release and/or revision. Future studies are necessary to determine whether the degree of AUR is related to the procedure or pre-existing bladder dysfunction.

Transurethral electrical stimulation for intraoperative bulbocavernosus reflex monitoring during spine surgery in females

ObjectiveIntraoperative bulbocavernosus reflex (BCR) monitoring is more difficult in females than in males. This study was designed to compare the feasibility of transurethral electrical stimulation BCR (tu-BCR) monitoring with that of conventional BCR (c-BCR) monitoring during spine surgery in females. MethodsTwenty-four females were included. For stimulation in c-BCR monitoring, a pair of surface electrodes was placed on the genitals (cathode/anode: clitoris/adjacent labium). For stimulation in tu-BCR monitoring, a urethral catheter attached to a pair of electrodes was inserted into the urethra. BCRs were recorded from the external anal sphincter after a single train of four stimulation pulses. ResultsThere was no postoperative urinary tract injury associated with urethral catheter insertion for tu-BCR. Tu-BCR monitoring had a significantly higher success rate of baseline recording than c-BCR monitoring (87.5% vs 66.7%, respectively, p = 0.028). The specificities of tu-BCR and c-BCR monitoring were 100% and 87.2%, respectively. The sensitivity was not calculated because no patients had postoperative urinary or bowel dysfunction. ConclusionsOur data indicate that tu-BCR monitoring improved the success rate of baseline recording and specificity during spine surgery in females. SignificanceTu-BCR monitoring was more reliable than c-BCR monitoring during spine surgery in females.

Does neoadjuvant chemoradiotherapy increase the effect of lateral lymph node dissection on urogenital function?

BackgroundIt is unclear whether neoadjuvant chemoradiotherapy (nCRT) has a deleterious influence on urogenital function in rectal cancer patients who undergone lateral lymph node dissection (LLND). The purpose of this study was to determine the incidence of urogenital dysfunction following total mesorectal excision (TME) + LLND with or without nCRT for mid-low rectal cancer, as well as to investigate the factors that predict urogenital dysfunction.MethodsFrom January 2015 to December 2020, a total of 106 consecutive patients who underwent TME + LLND surgery for mid-low rectal cancer were reviewed. Patients were divided into two groups based on whether they had undergone nCRT (n=51) or not (n=55).ResultsOverall, 106 patients responded to the questionnaires. nCRT was not associated with urinary dysfunction [International Prostatic Symptom Score (IPSS): 9.86 vs. 9.43, P=0.778; postoperative urinary dysfunction: 51.0% vs. 34.5%, P=0.087] or male sexual dysfunction [International Index Erectile Function (IIEF) score: 18.45 vs. 18.42, P=0.980; postoperative sexual dysfunction: 61.3% vs. 54.8%, P=0.607]. According to the univariable analyses, tumour distance from the anal verge ≤4 cm (P=0.029) and type of operation (P=0.020) were associated with an increased risk of urinary dysfunction; patients’ age (P=0.026) and type of LLND (P=0.044) were candidate risk factors for male sexual dysfunction. However, multivariable analyses showed that tumour distance from the anal verge was independently associated with urinary dysfunction (OR =2.505; 95% CI: 1.080–5.813; P=0.032); patients’ age was an independent risk factor for male sexual dysfunction (OR =3.654; 95% CI: 1.028–12.982; P=0.045).ConclusionsIn rectal cancer patients who had LLND, nCRT showed no significant additive effect on genitourinary function as compared to individuals who had TME + LLND alone. Urinary dysfunction was linked to the distance between the tumor and the anal margin, while age was an independent predictor of sexual dysfunction.

Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review

Sphincter preservation and organ restoration during rectal cancer surgery avoids permanent stoma creation and diminishes psychosocial damages. However, decreased rectal volumes and sphincter dysfunction—including pelvic nerve damage—results in low anterior resection syndrome, as well as urinary and sexual dysfunction after rectal resection. Bowel habit changes such as fecal incontinence, fecal urgency, frequent bowel movements, clustered stools, and difficulties in bowel emptying can be treated using medications, pelvic floor rehabilitation, sacral neuromodulation, or neorectal reservoir reconstruction. Pelvic nerve damage resulting from superior and inferior hypogastric plexi during sphincter-preserving rectal cancer surgery can induce urologic and sexual dysfunctions. Preoperative voiding difficulty, perioperative blood loss, and autonomic nerve injury are considered independent risk factors for postoperative urinary dysfunction. Retrograde ejaculation and erectile dysfunction, female dyspareunia, and vaginal dryness are manifestations of sexual dysfunction resulting from autonomic nerve injury during rectal cancer surgery. Multifactorial causes for functional outcomes after sphincter- preserving surgeries are considered to improve patient’s quality of life with acceptable oncologic outcomes in the treatment of rectal cancer patients.

Automated non-invasive identification of pelvic autonomic nerves with a handheld Raman spectrometer and potential application to nerve-sparing colorectal surgery: a preliminary study in surgical specimens.

BackgroundAlthough minimally invasive surgery for colorectal cancer, whether performed as standard laparoscopic or robotic surgery, has been established as an oncologically safe procedure, postoperative urinary dysfunction and sexual dysfunction remain matters of concern, even when so-called nerve-sparing surgery is performed. We have hypothesized that Raman spectroscopy can be used intraoperatively as a non-invasive label-free means of objective identification of the pelvic nerves, and we conducted a preliminary study by applying a newly developed handheld Raman spectrometer to surgical specimens.MethodsSamples of nervous tissue, colon cancer tissue, and tissues from surrounding pelvic organs were obtained from 25 patients undergoing colectomy. Raman spectra were obtained by irradiation with the Progeny™ Raman spectrometer. We looked for characteristic Raman shifts to distinguish nervous tissue from cancer tissue. To improve discrimination between nervous tissue and other tissues, the spectral data were subjected to principal component analysis.ResultsWe detected characteristic differences in the spectra at 1,309 cm−1, 1,442 cm−1, and 1,658 cm−1. A significant difference was detected at 1,442 cm−1, and accuracy of the modality for identification of nervous tissue was 75%. The addition of principle component analysis (4 components) yielded 100% sensitivity, 85% specificity, and 90%, notably increasing accuracy from 75% to 90% in discriminating between nervous tissue and cancer tissue.ConclusionsRaman spectroscopy holds promise for non-invasive intraoperative recognition of nervous tissue. We expect the modality to become a powerful clinical tool, compensating for the lack of tactile feedback intrinsic to minimally invasive colectomy and thus thwarting the risk of postoperative urinary and/or sexual dysfunction.