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Urinary Dysfunction in the Rectal Cancer Survivor

  • Cancer-Associated Voiding Dysfunction (A Peterson, Section Editor)
  • Published:
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Abstract

Improvements in diagnosis and treatment have resulted in significant improvement in survival rates for rectal cancer. This has led to increasing focus on post-treatment quality of life. One common sequela of treatment for rectal cancer is urinary dysfunction, defined as either difficulty voiding or incontinence. This consists of multiple clinical syndromes of distinct etiologies, most commonly dysfunction of the pelvic autonomic nerves or pelvic floor instability. This can vary in both duration and severity, with some patients experiencing transient and mild symptoms, while others experience prolonged functional impairment. A number of treatment options exist, including behavioral, pharmacologic, and surgical interventions. Because of the multifaceted nature of this process, optimal symptom relief requires careful evaluation of the severity and etiology of a patient’s complaints. Ultimately post-treatment urinary dysfunction can have a significant impact on quality of life, and it is important for clinicians to understand both the causes and management of this process.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Murty M, Enker WE, Martz J. Current status of total mesorectal excision and autonomic nerve preservation in rectal cancer. Semin Surg Oncol. 2000;19(4):321–8.

    Article  CAS  PubMed  Google Scholar 

  2. Sauer R et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30(16):1926–33.

    Article  CAS  PubMed  Google Scholar 

  3. Vironen JH et al. Impact of functional results on quality of life after rectal cancer surgery. Dis Colon Rectum. 2006;49(5):568–78.

    Article  PubMed  Google Scholar 

  4. Varpe P et al. Quality of life after surgery for rectal cancer with special reference to pelvic floor dysfunction. Colorectal Dis. 2011;13(4):399–405.

    Article  CAS  PubMed  Google Scholar 

  5. Inoue Y, Kusunoki M. Resection of rectal cancer: a historical review. Surg Today. 2010;40(6):501–6.

    Article  PubMed  Google Scholar 

  6. Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin. 1971;21(6):361–4.

    Article  CAS  PubMed  Google Scholar 

  7. Heald RJ. A new approach to rectal cancer. Br J Hosp Med. 1979;22(3):277–81.

    CAS  PubMed  Google Scholar 

  8. Moriya Y et al. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum. 1989;32(4):307–15.

    Article  CAS  PubMed  Google Scholar 

  9. Shirouzu K, Ogata Y, Araki Y. Oncologic and functional results of total mesorectal excision and autonomic nerve-preserving operation for advanced lower rectal cancer. Dis Colon Rectum. 2004;47(9):1442–7.

    Article  PubMed  Google Scholar 

  10. Enker WE. Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg. 1992;127(12):1396–401. discussion 1402.

    Article  CAS  PubMed  Google Scholar 

  11. Stewart DB, Dietz DW. Total mesorectal excision: what are we doing? Clin Colon Rectal Surg. 2007;20(3):190–202.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bleier JI, Maykel JA. Outcomes following proctectomy. Surg Clin North Am. 2013;93(1):89–106.

    Article  PubMed  Google Scholar 

  13. Chang PL, Fan HA. Urodynamic studies before and/or after abdominoperineal resection of the rectum for carcinoma. J Urol. 1983;130(5):948–51.

    CAS  PubMed  Google Scholar 

  14. Abrams P et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.

    Article  PubMed  Google Scholar 

  15. Steele SR et al. The evolution of evaluation and management of urinary or fecal incontinence and pelvic organ prolapse. Curr Probl Surg. 2015;52(3):92–136.

    Article  PubMed  Google Scholar 

  16. Sterk P et al. Voiding and sexual dysfunction after deep rectal resection and total mesorectal excision: prospective study on 52 patients. Int J Colorectal Dis. 2005;20(5):423–7.

    Article  PubMed  Google Scholar 

  17. Havenga K, Enker WE. Autonomic nerve preserving total mesorectal excision. Surg Clin North Am. 2002;82(5):1009–18.

    Article  PubMed  Google Scholar 

  18. Havenga K et al. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg. 1996;182(6):495–502.

    CAS  PubMed  Google Scholar 

  19. Pocard M et al. A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer. Surgery. 2002;131(4):368–72.

    Article  PubMed  Google Scholar 

  20. Moriya Y. Function preservation in rectal cancer surgery. Int J Clin Oncol. 2006;11(5):339–43.

    Article  PubMed  Google Scholar 

  21. Lange MM et al. Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg. 2008;95(8):1020–8.

    Article  CAS  PubMed  Google Scholar 

  22. Duran E, et al. Urinary and sexual dysfunction rates and risk factors following rectal cancer surgery. Int J Color Dis. 2015.

  23. Andersson J et al. Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II). Br J Surg. 2014;101(10):1272–9. The COLOR II trial provided valuable information about the epidemiology of urinary dysfunction, particularly with regard to the impact of surgical approach, but also offered large-scale patient reported data. This was particularly important due to the psychosocial importance of genitourinary function.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Jayne D et al. Five‐year follow‐up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010;97(11):1638–45.

    Article  CAS  PubMed  Google Scholar 

  25. Tekkis PP et al. Measuring sexual and urinary outcomes in women after rectal cancer excision. Dis Colon Rectum. 2009;52(1):46–54.

    Article  CAS  PubMed  Google Scholar 

  26. Junginger T, Kneist W, Heintz A. Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision. Dis Colon Rectum. 2003;46(5):621–8.

    Article  CAS  PubMed  Google Scholar 

  27. Kneist W et al. Identification of pelvic autonomic nerves during partial and total mesorectal excision--influence parameters and significance for neurogenic bladder. Chirurg. 2004;75(3):276–83.

    Article  CAS  PubMed  Google Scholar 

  28. Kneist W, Heintz A, Junginger T. Intraoperative identification and neurophysiologic parameters to verify pelvic autonomic nerve function during total mesorectal excision for rectal cancer. J Am Coll Surg. 2004;198(1):59–66.

    Article  PubMed  Google Scholar 

  29. Akasu T, Sugihara K, Moriya Y. Male urinary and sexual functions after mesorectal excision alone or in combination with extended lateral pelvic lymph node dissection for rectal cancer. Ann Surg Oncol. 2009;16(10):2779–86.

    Article  PubMed  Google Scholar 

  30. Kyo K et al. Impact of autonomic nerve preservation and lateral node dissection on male urogenital function after total mesorectal excision for lower rectal cancer. World J Surg. 2006;30(6):1014–9.

    Article  PubMed  Google Scholar 

  31. Kobayashi H et al. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum. 2009;52(4):567–76.

    Article  PubMed  Google Scholar 

  32. Sugihara K et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49(11):1663–72.

    Article  PubMed  Google Scholar 

  33. Sawkar HP et al. Frequency of lower urinary tract injury after gastrointestinal surgery in the nationwide inpatient sample database. Am Surg. 2014;80(12):1216–21. This study illustrated the effect of minimally invasive surgical techniques on urinary tract injury, finding a decrease in injury with laparoscopy compared with open surgery. This data further supports the increasing use of laparoscopic approaches to pelvic surgery and rectal cancer in particular.

    PubMed  Google Scholar 

  34. Yang L et al. Quality of life outcomes following laparoscopic total mesorectal excision for low rectal cancers: a clinical control study. Eur J Surg Oncol. 2007;33(5):575–9.

    Article  CAS  PubMed  Google Scholar 

  35. Jayne DG et al. Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg. 2005;92(9):1124–32.

    Article  CAS  PubMed  Google Scholar 

  36. Quah HM et al. Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg. 2002;89(12):1551–6.

    Article  CAS  PubMed  Google Scholar 

  37. Asoglu O et al. Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc. 2009;23(2):296–303.

    Article  PubMed  Google Scholar 

  38. McGlone ER et al. Urogenital function following laparoscopic and open rectal cancer resection: a comparative study. Surg Endosc. 2012;26(9):2559–65.

    Article  PubMed  Google Scholar 

  39. Lim RS, Yang TX, Chua TC. Postoperative bladder and sexual function in patients undergoing surgery for rectal cancer: a systematic review and meta-analysis of laparoscopic versus open resection of rectal cancer. Tech Coloproctol. 2014;18(11):993–1002.

    Article  CAS  PubMed  Google Scholar 

  40. Morelli L, et al. Sexual and urinary functions after robot-assisted versus pure laparoscopic total mesorectal excision for rectal cancer. Int J Color Dis. 2015.

  41. D’Annibale A et al. Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc. 2013;27(6):1887–95.

    Article  PubMed  Google Scholar 

  42. Park SY et al. Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer: a case-matched comparison. World J Surg. 2014;38(7):1834–42.

    Article  PubMed  Google Scholar 

  43. Broholm M, Pommergaard HC, Gogenur I. Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis. 2015;17(5):375–81.

    Article  CAS  PubMed  Google Scholar 

  44. Keller DS et al. Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc. 2014;28(1):212–21. With increasing scrutiny being applied to the use of robotics within colorectal surgery, this study provided important early data regarding outcomes with this approach, highlighting that the increases in cost and operative time are not offset by improved outcomes.

    Article  PubMed  Google Scholar 

  45. Elliott SP, Malaeb BS. Long-term urinary adverse effects of pelvic radiotherapy. World J Urol. 2011;29(1):35–41.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Bernard S, et al. Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review. J Cancer Surv. 2015.

  47. Lange MM, van de Velde CJ. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol. 2011;8(1):51–7.

    Article  PubMed  Google Scholar 

  48. Khandelwal C, Kistler C. Diagnosis of urinary incontinence. Am Fam Physician. 2013;87(8):543–50.

    PubMed  Google Scholar 

  49. Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth. 2015;62(2):203–18.

    Article  PubMed  Google Scholar 

  50. Kwaan MR et al. Early removal of urinary catheters after rectal surgery is associated with increased urinary retention. Dis Colon Rectum. 2015;58(4):401–5.

    Article  PubMed  Google Scholar 

  51. Lee SY et al. Risk factors and preventive measures for acute urinary retention after rectal cancer surgery. World J Surg. 2015;39(1):275–82.

    Article  PubMed  Google Scholar 

  52. Owen RM et al. Impact of surgical care improvement project inf-9 on postoperative urinary tract infections: do exemptions interfere with quality patient care? Arch Surg. 2012;147(10):946–53.

    Article  PubMed  Google Scholar 

  53. Yoo BE et al. Early removal of the urinary catheter after total or tumor-specific mesorectal excision for rectal cancer is safe. Dis Colon Rectum. 2015;58(7):686–91.

    Article  PubMed  Google Scholar 

  54. Poylin V et al. Perioperative use of tamsulosin significantly decreases rates of urinary retention in men undergoing pelvic surgery. Int J Colorectal Dis. 2015;30(9):1223–8.

    Article  PubMed  Google Scholar 

  55. Averch TD et al. AUA white paper on catheter associated urinary tract infections: definitions and significance in the urological patient. Urol Pract. 2014;2:321–8.

    Article  Google Scholar 

  56. Qaseem A et al. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(6):429–40.

    Article  PubMed  Google Scholar 

  57. Dumoulin C, Hay-Smith EJ, Mac Habee-Seguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014;5:CD005654.

    PubMed  Google Scholar 

  58. Burgio KL. Update on behavioral and physical therapies for incontinence and overactive bladder: the role of pelvic floor muscle training. Curr Urol Rep. 2013;14(5):457–64.

    Article  PubMed  Google Scholar 

  59. Anderson CA et al. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev. 2015;1:CD001843.

    PubMed  Google Scholar 

  60. Glazener C et al. Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS): two parallel randomised controlled trials. Lancet. 2011;378(9788):328–37.

    Article  PubMed  Google Scholar 

  61. Shamliyan T et al. Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review. Ann Intern Med. 2012;156(12):861–74. W301-10.

    Article  PubMed  Google Scholar 

  62. Kaplan SA et al. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA. 2006;296(19):2319–28.

    Article  CAS  PubMed  Google Scholar 

  63. Cui Y et al. The efficacy and safety of mirabegron in treating OAB: a systematic review and meta-analysis of phase III trials. Int Urol Nephrol. 2014;46(1):275–84.

    Article  CAS  PubMed  Google Scholar 

  64. Visco AG et al. Anticholinergic therapy vs. onabotulinumtoxina for urgency urinary incontinence. N Engl J Med. 2012;367(19):1803–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. van Kerrebroeck PE et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007;178(5):2029–34.

    Article  PubMed  Google Scholar 

  66. Siegel S et al. Results of a prospective, randomized, multicenter study evaluating sacral neuromodulation with InterStim therapy compared to standard medical therapy at 6-months in subjects with mild symptoms of overactive bladder. Neurourol Urodyn. 2015;34(3):224–30.

    Article  PubMed  Google Scholar 

  67. Laudano MA et al. Disparities in the use of sacral neuromodulation among medicare beneficiaries. J Urol. 2015;194(2):449–53.

    Article  PubMed  Google Scholar 

  68. Li J et al. The role of duloxetine in stress urinary incontinence: a systematic review and meta-analysis. Int Urol Nephrol. 2013;45(3):679–86.

    Article  CAS  PubMed  Google Scholar 

  69. Alan C et al. Efficacy of duloxetine in the early management of urinary continence after radical prostatectomy. Curr Urol. 2015;8(1):43–8.

    Article  PubMed  PubMed Central  Google Scholar 

  70. MacLachlan LS, Rovner ES. New treatments for incontinence. Adv Chronic Kidney Dis. 2015;22(4):279–88.

    Article  PubMed  Google Scholar 

  71. Gross C et al. Sacral neuromodulation for nonobstructive urinary retention: a meta-analysis. Female Pelvic Med Reconstr Surg. 2010;16(4):249–53.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA

    Brian Gilmore, Brian Ezekian, Zhifei Sun, Andrew Peterson & Christopher Mantyh

Authors
  1. Brian Gilmore
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  2. Brian Ezekian
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  3. Zhifei Sun
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  4. Andrew Peterson
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  5. Christopher Mantyh
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Correspondence to Brian Gilmore.

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Drs Gilmore, Ezekian, Sun, and Mantyh declare no conflicts of interest.

Dr. Peterson reports grants from American medical systems, grants from Coloplast, outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by the author.

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This article is part of the Topical Collection on Cancer-Associated Voiding Dysfunction

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Gilmore, B., Ezekian, B., Sun, Z. et al. Urinary Dysfunction in the Rectal Cancer Survivor. Curr Bladder Dysfunct Rep 11, 105–112 (2016). https://doi.org/10.1007/s11884-016-0357-4

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