The prevalence of urinary and sexual dysfunction following rectal excision

Abstract

INTRODUCTION: With improved survival following rectal excision for cancer and focus on nerve sparing operation, recent interest has centered on urinary and sexual dysfunction. OBJECTIVE: To identify the prevalence of urinary and sexual dysfunction in patients after rectal excision.METHODS: 43 patients (17 male, median age 55 years, range 24 to 74) underwent anterior resection (23), restorative proctocolectomy (13), abdomino-perineal excision (04), and rectal excision as part of subtotal colectomy (03). Structured interview was performed at least 03 months after stoma closure. Data were compared with age and gender matched controls. Statistical evaluation was by the McNemar test and test of proportions. Significance was assigned to a P value <0.05. RESULTS: Median (range) duration after operation was 28 months (8 - 84). Preoperatively, urinary function was similar in patients and controls. After operation, a significant number of patients had transient urinary dysfunction [urinary symptoms, pre vs post; 07 (16%) vs. 28 (65%) p< 0.05]. Long-term prevalence of poor stream and urinary hesitancy after operation were significant [poor stream; pre vs. post- 6 vs. 16: P=0.006 and hesitancy; pre vs. post - 6 vs. 18: P=0.004]. Sexual function was also significantly reduced in patients after operation [sexually active; pre vs. post- 29 vs. 17: P=0.004]. Fourteen (9 male,5 female) of 29 (48%) reported transient abstinence from sexual activity 6 months after operation whilst eight of 29 (27 .5%) reported more permanent abstinence (lack of interest-6, dyspareunia-1, erectile failure/ retrograde ejaculation - 7). CONCLUSION: Counseling regarding sexual and urinary function should be an integral part of the pre-operative work-up in patients having rectal excision