Vesicourethral dysfunction following radical surgery for rectal carcinoma: change in voiding pattern on sequential urodynamic studies and impact of nerve-sparing surgery.

OBJECTIVES

Urodynamic studies were performed to clarify vesicourethral dysfunction and recovery after rectal surgery for cancer.

MATERIALS AND METHODS

At 1, and 6 to 1 2 months after rectal surgery interviews and urodynamic studies (UDS) were performed on 51 consecutive patients, all without a prior history of voiding disorder (40 males and 11 females; median age, 60 years). Patients were divided into 2 groups, either with (preserved group, n = 17) or without (nonpreserved group, n = 34) preservation of the bilateral pelvic plexus during surgery. Comparisons of voiding status and urodynamic parameters were made between the 2 groups.

RESULTS

By 1 and 6 months after the operation normal voiding was achieved in 71% (12/17) and 100% (13/13) of patients in the preserved group, and 6% (2/34) and 30% of patients (9/30) in the nonpreserved group, respectively (P < 0.001). Attainment of normal voiding in the nonpreserved group was preceded by the recovery of bladder sensation, while UDS demonstrated increases in vesical compliance and the disappearance of vesical denervation supersensitivity.

CONCLUSION

A nerve-sparing procedure during radical surgery for rectal carcinoma preserved vesicourethral function. The urodynamic parameters relevant to postoperative recovery of voiding function were improved vesical compliance, disappearance of vesical denervation supersensitivity, and recovery of a bladder filling sensation.