Abstract
Surgical treatment of rectal cancer is associated with a risk of autonomic nerve damage, and consequence of this may be sexual and urinary dysfunction. The improvement of our understanding of the anatomy and physiology of sexual and urinary function together with continual sophistication of surgery for rectal cancer has decreased the incidence of sexual and urinary dysfunction after rectal surgery. Despite these advances, mentioned functional deficits still present significant factor in the impaired quality of life of these patients. Awareness of the degree of risk for postoperative sexual and urinary dysfunction is important both for the patient and as a standard for appraisal of individual colorectal practice.
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Aigner F, Zbar AP et al (2004) The rectogenital septum: morphology, function, and clinical relevance. Dis Colon Rectum 47(2):131–140
Bernstein WC, Bernstein EF (1966) Sexual dysfunction following radical surgery for cancer of the rectum. Dis Colon Rectum 9(5):328–332
Bevan KE, Moran BJ (2009) Optimizing rectal cancer surgery by total mesorectal excision and “cylindrical” extralevator techniques for abdominoperineal excision. Curr Colorectal Cancer Rep 5(4):219–223
Camilleri-Brennan J, Steele RJC (1998) Quality of life after treatment for rectal cancer. Br J Surg 85(8):1036–1043
Church JM, Raudkivi PJ et al (1987) The surgical anatomy of the rectum - a review with particular relevance to the hazards of rectal mobilisation. Int J Colorectal Dis 2(3):158–166
Clausen N, Wolloscheck T et al (2008) How to optimize autonomic nerve preservation in total mesorectal excision: clinical topography and morphology of pelvic nerves and fasciae. World J Surg 32(8):1768–1775
Da Silva GM, Zmora O et al (2004) The efficacy of a nerve stimulator (Cavermap®) to enhance autonomic nerve identification and confirm nerve preservation during total mesorectal excision. Dis Colon Rectum 47(12):2032–2038
Denonvilliers C (1836) Anatomie du perinée. Bull Soc Anat 3rd Series Paris 11: 105–106
Enker WE, Thaler HT et al (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181(4):335–346
Fazio VW, Fletcher J et al (1980) Prospective study of the effect of resection of the rectum on male sexual function. World J Surg 4(2):149–152
Goligher J (1960) Colon, rectum, and anus – surgical. Med Annu 78:40–53
Guillou PJ, Quirke P et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726
Havenga K, Enker WE et al (1996) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182(6):495–502
Havenga K, Maas CP et al (2000) Avoiding long-term disturbance to bladder and sexual function in pelvic surgery, particularly with rectal cancer. Semin Surg Oncol 18(3):235–243
Heald B (2008) Autonomic nerve preservation in rectal cancer surgery – the forgotten part of the TME message a practical “workshop” description for surgeons. Acta Chir Iugosl 55(3):11–16
Heald RJ (1988) The ‘Holy Plane’ of rectal surgery. J R Soc Med 81(9):503–508
Heald RJ, Moran BJ (1998) Embryology and anatomy of the rectum. Semin Surg Oncol 15(2):66–71
Heald RJ, Moran BJ et al (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133(8):894–899
Hendren SK, O’Connor BI et al (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242(2):212–223
Hill GL, Rafique M (1998) Extrafascial excision of the rectum for rectal cancer. Br J Surg 85(6):809–812
Hojo K, Vernava AM III et al (1991) Preservation of urine voiding and sexual function after rectal cancer surgery. Dis Colon Rectum 34(7):532–539
Holm T, Ljung A et al (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94(2):232–238
Huland H, Noldus J (1999) An easy and safe approach to separating Denonvilliers’ fascia from rectum during radical retropubic prostatectomy. J Urol 161(5):1533–1534
Jayne DG, Guillou PJ et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25(21):3061–3068
Jones OM, Smeulders N et al (1999) Lateral ligaments of the rectum: an anatomical study. Br J Surg 86(4):487–489
Jones OM, Stevenson ARL et al (2009) Preservation of sexual and bladder function after laparoscopic rectal surgery. Colorectal Dis 11(5):489–495
Junginger T, Kneist W et al (2003) Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision. Dis Colon Rectum 46(5):621–628
Keating JP (2004) Sexual function after rectal excision. ANZ J Surg 74(4):248–259
Kim NK, Aahn TW et al (2002) Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer. Dis Colon Rectum 45(9):1178–1185
Kiyoshima K, Yokomizo A et al (2004) Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol 34(8):463–468
Kneist W, Junginger T (2007) Intraoperative electrostimulation objectifies the assessment of functional nerve preservation after mesorectal excision. Int J Colorectal Dis 22(6):675–682
Lange MM, Maas CP et al (2008) Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg 95(8):1020–1028
Lin M, Chen W et al (2010) The anatomy of lateral ligament of the rectum and its role in total mesorectal excision. World J Surg 34(3):594–598
Lindsey I, George BD et al (2001) Impotence after mesorectal and close rectal dissection for inflammatory bowel disease. Dis Colon Rectum 44(6):831–835
Lindsey I, Guy RJ et al (2000) Anatomy of denonviliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 87(10):1288–1299
Lindsey I, Warren BF et al (2005) Denonvilliers’ fascia lies anterior to the fascia propria and rectal dissection plane in total mesorectal excision. Dis Colon Rectum 48(1):37–42
Maas CP, Moriya Y et al (1998) Radical and nerve-preserving surgery for rectal cancer in the Netherlands: a prospective study on morbidity and functional outcome. Br J Surg 85(1):92–97
Maas CP, Moriya Y et al (2000) A prospective study on radical and nerve-preserving surgery for rectal cancer in the Netherlands. Eur J Surg Oncol 26(8):751–757
Masui H, Ike H et al (1996) Male sexual function after autonomic nerve-preserving operation for rectal cancer. Dis Colon Rectum 39(10):1140–1145
Mauroy B, Demondion X et al (2007) The female inferior hypogastric (= pelvic) plexus: anatomical and radiological description of the plexus and its afferences – applications to pelvic surgery. Surg Radiol Anat 29(1):55–66
McArdle CS, McMillan DC et al (2003) Male gender adversely affects survival following surgery for colorectal cancer. Br J Surg 90(6):711–715
McDonald PJ, Heald RJ (1983) A survey of postoperative function after rectal anastomosis with circular stapling devices. Br J Surg 70(12):727–729
Moriya Y (2006) Function preservation in rectal cancer surgery. Int J Clin Oncol 11(5):339–343
Moriya Y, Hojo K et al (1989) Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 32(4):307–315
Moriya Y, Sugihara K et al (1995) Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancer. Eur J Cancer Part A: Gen Top 31(7–8):1229–1232
Mundy AR (1982) An anatomical explanation for bladder dysfunction following rectal and uterine surgery. Br J Urol 54(5):501–504
Nano M, Levi AC et al (1998) Observations on surgical anatomy for rectal cancer surgery. Hepatogastroenterology 45(21):717–726
Nesbakken A, Nygaard K et al (2000) Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 87(2):206–210
Platell CFE, Thompson PJ et al (2004) Sexual health in women following pelvic surgery for rectal cancer. Br J Surg 91(4):465–468
Quah HM, Jayne DG et al (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89(12):1551–1556
Rullier E, Sa Cunha A et al (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90(4):445–451
Sato K, Sato T (1991) The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia. Surg Radiol Anat 13(1):17–22
Schlegel PN, Walsh PC (1987) Neuroanatomical approach to radical cystoprostatectomy with preservation of sexual function. J Urol 138(6):1402–1406
Schwalenberg T, Neuhaus J et al (2010) Neuroanatomy of the male pelvis in respect to radical prostatectomy including three-dimensional visualization. BJU Int 105(1):21–27
Silver PH (1956) The role of the peritoneum in the formation of the septum recto-vesicle. J Anat 90(4):538–546
Sugihara K, Moriya Y et al (1996) Pelvic autonomic nerve preservation for patients with rectal carcinoma: oncologic and functional outcome. Cancer 78(9):1871–1880
Takahashi T, Ueno M et al (2000) Lateral ligament: its anatomy and clinical importance. Semin Surg Oncol 19(4):386–395
Tawk RG, Ondra SL et al (2002) Intraoperative parasympathetic nerve stimulation with tumescence monitoring during total mesorectal excision for rectal cancer. J Am Coll Surg 195(4):506–512
Tekkis PP, Cornish JA et al (2009) Measuring sexual and urinary outcomes in women after rectal cancer excision. Dis Colon Rectum 52(1):46–54
Uchimoto K, Murakami G et al (2007) Rectourethralis muscle and pitfalls of anterior perineal dissection in abdominoperineal resection and intersphincteric resection for rectal cancer. Anat Sci Int 82(1):8–15
Wallner C, Lange MM et al (2008) Causes of fecal and urinary incontinence after total mesorectal excision for rectal cancer based on cadaveric surgery: a study from the cooperative clinical investigators of the Dutch total mesorectal excision trial. J Clin Oncol 26(27):4466–4472
Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds) (2003) Campbell’s urology. Elsevier Science, Philadelphia
Weinstein M, Roberts M (1977) Sexual potency following surgery for rectal carcinoma. A follow-up of 44 patients. Ann Surg 185(3):295–300
West NP, Anderin C et al (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97(4):588–599
West NP, Finan PJ et al (2008) Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol 26(21):3517–3522
Wichmann MW, Muller C et al (2001) Gender differences in long-term survival of patients with colorectal cancer. Br J Surg 88(8):1092–1098
Williams DI, Watson PC et al (1951) Discussion on urological complications of excision of the rectum. Proc R Soc Med 44(9):819–828
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Krivokapic, Z., Dimitrijevic, I. (2012). How Is Nerve-Sparing Surgery Well Performed?. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25005-7_24
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DOI: https://doi.org/10.1007/978-3-642-25005-7_24
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