Recovery of Urinary Functions After Laparoscopic Total Mesorectal Excision for T4 Rectal Cancer

Postoperative urinary dysfunction after total mesorectal excision (TME) is lessened by preservation of the autonomic nerves, but in T4 rectal tumors such injury often cannot be prevented. This retrospective study evaluated the recovery of urinary function of patients with injury to a single pelvic autonomic nerve subsequent to laparoscopic TME, relative to patients without nerve damage.

Patients with T4 rectal cancer who underwent laparoscopic TME were divided according to the presence of a single pelvic autonomic nerve injury (37 cases) or no injury to autonomic nerves (54 cases; control). Urinary function was evaluated before surgery and at 1 and 6 months after surgery based on catheter indwelling time, urodynamics, International Prostate Symptom Score (IPSS; men only), and Urogenital Distress Inventory (UDI-6) score (women).

One month after surgery in the injured and control groups, the postoperative catheter indwelling time was 6.2 ± 2.0 and 1.9 ± 1.2 days, respectively; the maximal urinary flow rates were 16.6 ± 5.8 and 19.7 ± 5.5 mL/s; the voided volumes were 181.6 ± 65.9 and 211.7 ± 63.2 mL; and the residual volumes were 15.0 ± 8.5 and 10.8 ± 8.0 mL. However, at the 6-month follow-up, all urodynamic parameters of the two groups were statistically similar and indicated recovery, and the IPSS and UDI-6 scores were also not statistically different.

Damage to a single pelvic autonomic nerve during laparoscopic TME does not lead to long-term urinary dysfunction.