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Original Article
Assessment of Sexual and Voiding Function after Total Mesorectal Excision with Pelvic Autonomic Nerve Preservation in Male Rectal Cancer Patients.
Kim, Nam Kyu , Aahn, Tae Wan , Park, Jea Kun , Lee, Kang Young , Lee, Wong Hee , Sohn, Seung Kook , Min, Jin Sik
Journal of the Korean Society of Coloproctology 2002;18(5):287-293

1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
2Department of Urology, Yonsei University College of Medicine, Seoul, Korea.
3JaeSeng Medical Center, Seoul, Korea.
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Abstract

PURPOSE
The aim of this study was to assess the safety of TME with pelvic autonomic nerve preservation in male rectal cancer patients in terms of voiding and sexual function.
METHODS
We performed uroflowmetry using Urodyn (Dantec, Denmark) and a standard questionnaire employing the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) pre- and postoperatively in 68 male rectal cancer patients.
RESULTS
There were significant differences of mean maximal flow rate and voided volume 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, there was no difference of residual volume before and after surgery (4.4 2.6 vs 8.1 4.4, P>0.05). The total IPSS (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 seven IPSS items in from 49 patients (73.5 percent) to 61 patients (89.7 percent). Five IIEF (International Index of Erectile Function) domain score (erectile function, intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction) was statistically decreased after surgery (18.2+/-9.3 vs 13.5+/-9.0, 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+/-2.0, 6.1+/-2.2 vs. 4.5+/-2.3, P<0.05, respectively. Erection was possible in 55 patients (80.9 percent), but penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in 3 patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). IIEF domains such as sexual desire and overall satisfaction were markedly decreased in 39 patients (57.4 percent), 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that over 60 years (sexual desire: P=0.019), within 6 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.
CONCLUSIONS
TME with pelvic autonomic nerve preservation technique showed a safety and comparable data in preserving sexual and voiding function. The IPSS and IIEF questionnaire were useful and more investigative in assessing urinary and sexual function.

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