Anorectal and urinary dysfunction after surgery for rectal cancer

Despite several studies conducted, the relationship between anorectal and urinary dysfunction has not been ultimately determined.

Forty four patients have been included into the study and divided into three groups according to the type of procedure: Group A - abdomino-perineal resection, group B - low anterior resection and group C - local excision. The urodynamic workup performed 5-9 months after surgical procedure consisted of uroflowmetry, residual urine volume measurement, and cystometry. The following urodynamic parameters were evaluated: sensory threshold, maximal urethral flow within first 30% of voiding time and during the first 5 seconds. Residual volume was controlled by abdominal ultrasound. Anal pressure profile was recorded for evaluation of resting and squeeze anal pressure, length of anal high-pressure zone, radial asymmetry and vector volume. Patients were asked to fulfil a standard questionnaire of voiding dysfunction and fecal continence.

Mean values for groups A, B and C revealed for anorectal symptoms 4.7 (SD 3.4), unaffordable symptoms 3.0 (SD 3.3), and for urinary symptoms 2.5 (SD 2.0), 2.9 (SD 1.9), 0.2 (SD 0.6), respectively. Coexistence and aggravation of anorectal and/or urinary symptoms revealed high correspondence within group B (p = 0.055), while this kind of correlation was not observed in group C. Urinary disturbances suggested in uroflowmetric study were the most common in group B (90%). The percentage of patients with manometrically confirmed dysfunction after low anterior rectal resection was twice the value, as compared to the percentage of patients after local excision (p < 0.05).

Our data revealed significant correlation between anorectal and urinary dysfunction after rectal surgery and suggests partially similar pathomechanism of these malfunctions, mediated by direct damage to pelvic autonomic plexus during extended rectal dissection for oncological reasons.