gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2023-22-2-32-39gnck-1727Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESНейрогенная дисфункция мочевого пузыря у больных раком прямой кишки после тотальной мезоректумэктомииNeurogenic bladder dysfunction after total mesorectumectomyhttps://orcid.org/0000-0003-4355-329XАзимовЭ. Г.AzimovE. G.

Азимов Эльман Гарби оглы — канд. мед.наук

ул. Бакиханова, д. 23, г. Баку, AZ 1002, Азербайджан

Elman G. Azimov — Candidate of Medical Sciences

Bakikhanova st., 23, Baku, AZ 1002, Azerbaijan

https://orcid.org/0000-0002-3974-0781АлиевС. А.AliyevS. A.

Алиев Садай Агалар оглы — доктор мед.наук

ул. Бакиханова, д. 23, г. Баку, AZ 1002, Азербайджан

Saday A. Aliev — Doctor of Medical Sciences, Professor

Bakikhanova st., 23, Baku, AZ 1002, Azerbaijan

sadayaliyev1948@mail.ruАзербайджанский Медицинский Университет, кафедра хирургических болезней №1АзербайджанAzerbaijan Medical University, Department of Surgical Diseases No. 1Azerbaijan2023210620232223239Copyright © Азимов Э.Г., Алиев С.А., 20232023Азимов Э.Г., Алиев С.А.Azimov E.G., Aliyev S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1727ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ: изучение частоты, причин и особенностей клинического течения нейрогенной дисфункции мочевого пузыря у больных раком прямой кишки после тотальной мезоректумэктомии.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ: анализированы результаты хирургического лечения 103 больных раком прямой кишки в свете ближайших и отдаленных исходов, которым была выполнена тотальная мезоректумэктомия с использованием традиционной — у 56 (54,4%) и лапароскопической — у 47 (45,6%) технологий. У 20 (19,4%) из 103 больных течение ближайшего послеоперационного периода осложнилось развитием нейрогенной дисфункции мочевого пузыря. С целью изучения частоты нейрогенной дисфункции мочевого пузыря в зависимости от методики мезоректумэктомии, больные были разделены на 2 группы. В первую группу вошли 9 больных, которым выполнена лапароскопическая тотальная мезоректумэктомия. Во вторую группу включены 11 больных, перенесших традиционную (открытую) мезоректумэктомию.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: частота развития послеоперационной НДМП имеет гендерную зависимость (у мужчин — 25%, у женщин — 10,7%). В течение 1 недели и 6 мес. после операции средняя скорость мочеиспускания имеет тенденцию к повышению у женщин и снижению у мужчин, вне зависимости от методики тотальной мезоректумэктомии. В обеих группах не отмечено статистически значимое снижение максимальной объемной скорости как у мужчин, так и у женщин в течение 6 мес. после операции. В тоже время за указанный период наблюдалось снижение средней скорости мочеиспускания только у мужчин, вне зависимости от методики тотальной мезоректумэктомии. у женщин этот показатель оставался неизмененным или несколько повышенным.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: среди пациентов, перенесших мезоректумэктомию, НДМП развивается в 19,4%. Консервативные методы лечения НДМП эффективны в 90%.

AIM

AIM: to estimate the rate, causes and features of neurogenic bladder dysfunction in patients with rectal cancer after total mesorectumectomy.

PATIENTS AND METHODS

PATIENTS AND METHODS: the results of surgical treatment of 103 patients with rectal cancer were analyzed in the light of immediate and long-term outcomes, who underwent total mesorectumectomy using traditional (56-54.4%) and laparoscopic (47-45.6%) technologies. In 20 (19.4%) of 103 patients, the course of the immediate postoperative period was complicated by the development of neurogenic bladder dysfunction. In order to study the frequency of neurogenic bladder dysfunction depending on the technique of mesorectumectomy, the patients were divided into 2 groups. Group 1 included 9 patients who underwent laparoscopic total mesorectumectomy. Group 2 included 11patients who underwent traditional (open) mesorectumectomy.

RESULTS

RESULTS: the study of the functional state of the bladder according to the flowmetric indicators revealed that the frequency of development of postoperative bladder dysfunction has a gender dependence. The frequency of neurogenic bladder dysfunction was 25% in men and 10,7% in women. It is shown that during 1 week and 6 months after surgery, the average urination rate tends to increase in women and decrease in men, regardless of the technique of total mesorectumectomy. In both groups, there was not a statistically significant decrease in the maximum volumetric velocity in both men and women within 6 months after surgery. At the same time, during this period, there was a decrease in the average rate of urination only in men, regardless of the technique of total mesorectumectomy. And in women, this indicator remained unchanged or slightly increased.

CONCLUSION

CONCLUSION: it is shown that a complex system of therapeutic measures, including drug stimulation of the detrusor and urethral sphincter, repeated catheterization of the bladder, as well as epicystostomy performed according to indications, allows adequate correction of bladder dysfunction after total mesorectumectomy in patients with rectal cancer.

рак прямой кишкитотальная мезоректумэктомияоткрытая тотальная мезоректумэктомиялапароскопическая тотальная мезоректумэктомиянейрогенная дисфункция мочевого пузыряrectal cancertotal mesorectumectomyopen total mesorectumectomylaparoscopic total mesorectumectomyneurogenic bladder dysfunctionReferencesЧиссов В.И., Франк Г.А., Сидоров Д.В., и соавт. Результаты хирургического и комбинированного лечения рака прямой кишки. Российский Онкологический Журнал. 2012;3:4–7.Chissov V.I., Frank G.A., Sidorov D.V., et al. Results of surgical and combination treatment for rectal cancer. Russian Oncol Journal. 2012;3:4–7. (In Russ.).Siegel Rl, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67(3):177–193. doi: 10.3322/caac.21395Siegel Rl, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67(3):177–193. doi: 10.3322/caac.21395Mannucci A, Zuppardo RA, Rozati R, et al. Colorectal cancer screening from 45 years of age: thesis, antithesis and synthesis. World J Gastroenterol. 2019;25(21):2565–2580. doi: 10.3748/wjg.v25i21.2565Mannucci A, Zuppardo RA, Rozati R, et al. Colorectal cancer screening from 45 years of age: thesis, antithesis and synthesis. World J Gastroenterol. 2019;25(21):2565–2580. doi: 10.3748/wjg.v25i21.2565Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality world-wide for 36 Cancer in 185 Countries. CA Cancer J Clin. 2021;71(3):209–249. doi: 10.3322/caac.21660Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality world-wide for 36 Cancer in 185 Countries. CA Cancer J Clin. 2021;71(3):209–249. doi: 10.3322/caac.21660Азимов Э.Г. Алиев С.А. Отдаленные результаты тотальной мезоректумэктомии у больных раком прямой кишки с применением традиционной и лапароскопической технологии. Колопроктология. 2019;18(3):41–48. doi: 10.33878/2073-7556-2019-18-3-41-48Azimov E.G, Aliyev S.A. Late results of total mesorectumectomy in rectal cancer after open and laparoscopic procedures. Koloproktologia. 2019; 18;3(69):41–48. (In Russ.). doi: 10.33878/2073-7556-2019-18-3-41-48Сидоров Д.В., Троицкий А.А., Ложкин М.В., и соавт. Ближайшие клинические и функциональные результаты после выполнения нервосохраняющих операций при раке прямой кишки. Онкология. Журнал им. П.А. Герцена. 2020;9(4):5–10. doi: 10.17116/onkolog202090415Sidorov D.V., Troitsky A.A., Lozhkin M.V., et al. Immediate clinical and functional results after nerve-sparing surgery for colorectal cancer. P.A.Herzen Journal of Oncology. 2020;9(4):5–10. (In Russ.). doi: 10.17116/onkolog202090415Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1449–1482. doi: 10.1016//s0140-6736(86)91510-2Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1449–1482. doi: 10.1016/s0140-6736(86)91510-2Deng WH, Zheng YB, Tong SL, et al. Efficiency analysis on functional protection of nerve plane-oriented laparoscopic total mesorectal excision. Zhonghua Wei Chang Wai Ke Za Zhi. 2019;22(12):1144–1151. doi: 10.3760/cma/j.issn.1671-0274.2019.12.009Deng WH, Zheng YB, Tong SL, et al. Efficiency analysis on functional protection of nerve plane-oriented laparoscopic total mesorectal excision. Zhonghua Wei Chang Wai Ke Za Zhi. 2019;22(12):1144–1151. doi: 10.3760/cma/j.issn.1671-0274.2019.12.009Kim NK, Kim HS, Alessa M, Torky R. Optimal complete rectum mobilization focused on the anatomy of the pelvic fascia and anatomic nerves: 30 years of experience at severance Hospital. Yonsei Med J. 2021;62(3):187–199. doi: 10.3349/ymj.2021.62.3.187Kim NK, Kim HS, Alessa M, Torky R. Optimal complete rectum mobilization focused on the anatomy of the pelvic fascia and anatomic nerves: 30 years of experience at severance Hospital. Yonsei Med J. 2021;62(3):187–199. doi: 10.3349/ymj.2021.62.3.187Fang I, Zheng Z, Wei H. Reconsideration of the anterior surgical plane of total mesorectal excision for rectal cancer. Dis Colon Rectum. 2019;62(5):639–641. doi: 10.1097/DCR.0000000000001358Fang I, Zheng Z, Wei H. Reconsideration of the anterior surgical plane of total mesorectal excision for rectal cancer. Dis Colon Rectum. 2019;62(5):639–641. doi: 10.1097/DCR.0000000000001358Kim NK, Kim YW, Cho MS. Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: expert technical tips for robotic surgery. Surg Oncol. 2015;24(3):172–180. doi: 10.1016/j.suronc.2015.06.012Kim NK, Kim YW, Cho MS. Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: expert technical tips for robotic surgery. Surg Oncol. 2015;24(3):172–180. doi: 10.1016/j.suronc.2015.06.012Tang JH, Ding PR. Autonomic nerve preserving in laparoscopic total mesorectal excision. J Xiangyua Med. 2017;2:43. doi: 10.21037/jxym.2017.04.03Tang JH, Ding PR. Autonomic nerve preserving in laparoscopic total mesorectal excision. J Xiangyua Med. 2017;2:43. doi: 10.21037/jxym.2017.04.03Chew M-H, Yeh Y-T, Lim E, Seow-Choen F. Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep (Oxf). 2016;4(3):173–185. doi: 10.1093/gastro/gow023Chew M-H, Yeh Y-T, Lim E, Seow-Choen F. Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep (Oxf). 2016;4(3):173–185. doi: 10.1093/gastro/gow023Kokelaar RF, Evans MD, Davies M, et al. Locally advanced rectal cancer: management callenges. Onco Targets Ther. 2016;9:6265–6272. doi: 10.2147/0TTS100806Kokelaar RF, Evans MD, Davies M, et al. Locally advanced rectal cancer: management callenges. Onco Targets Ther. 2016;9:6265–6272. doi: 10.2147/0TTS100806Kumar NAN, Kammar P, Saklani A. Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer. Mini-invasive Surg. 2018;2:19. doi: 10.20517/2574-1225.2018.26Kumar NAN, Kammar P, Saklani A. Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer. Mini-invasive Surg. 2018;2:19. doi: 10.20517/2574-1225.2018.26Chill HH, Parnasa SY, Shussman N, et al. Urinary disfunction in women following total mesorectal excision versus partial mesorectal excision for treatment of rectal cancer. BMC Women’s Health. 2021; 21;237. doi: 10.1186/s12905-021-013381-7Chill HH, Parnasa SY, Shussman N, et al. Urinary disfunction in women following total mesorectal excision versus partial mesorectal excision for treatment of rectal cancer. BMC Women’s Health. 2021; 21;237. doi: 10.1186/s12905-021-013381-7George D, Pramil K, Kamalesh NP, et al. Sexual and urinary dysfunction following laparoscopic total mesorectal excision in male patients: a prospecyive study. Journal of Minimal Access Surgery. 2018;149(2):111–117. doi: 10.4103/jmas.JMAS_93_17George D, Pramil K, Kamalesh NP, et al. Sexual and urinary dysfunction following laparoscopic total mesorectal excision in male patients: a prospecyive study. Journal of Minimal Access Surgery. 2018;149(2):111–117. doi: 10.4103/jmas.JMAS_93_17Dulskas A, Samalavicius NE. A prospective study of sexual and urinary function before and after total mesorectal excision. Int J Colorectal Dis. 2016;31:1125–1130. doi: 10.1007/s00384-016-2549-yDulskas A, Samalavicius NE. A prospective study of sexual and urinary function before and after total mesorectal excision. Int J Colorectal Dis. 2016;31:1125–1130. doi: 10.1007/s00384-016-2549-yQiao Q, Che X, Li X, et al. Recovery of urinary functions after laparoscopic total mesorectal excision for T4 rectal cancer. J Laparoendosc Adv Surg Tech A. 2016;26(8):614–617. doi: 10.1089/lap.2015.0479Qiao Q, Che X, Li X, et al. Recovery of urinary functions after laparoscopic total mesorectal excision for T4 rectal cancer. J Laparoendosc Adv Surg Tech A. 2016;26(8):614–617. doi: 10.1089/lap.2015.0479Ha RK, Park Boram P, Park SCh, et al. Effect of lateral lymph node dissection on the quality of life and genitourinary function after neoadjuvant chemoradiotherapy for rectal cancer. Ann Surg Treat Res. 2021;100(2):109–118. doi: 10.4174/astr.2021.100.2.109Ha RK, Park Boram P, Park SCh, et al. Effect of lateral lymph node dissection on the quality of life and genitourinary function after neoadjuvant chemoradiotherapy for rectal cancer. Ann Surg Treat Res. 2021;100(2):109–118. doi: 10.4174/astr.2021.100.2.109Ito M, Kobayashi A, Fujita S, et al. Colorectal cancer study group of Japan Clinical Oncology Group. Urinary disfunction after rectal cancer surgery: results from a randomised trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or III lower rectal cancer (Japan Clinical Oncology Group Study. JCOG 0212. Eur J Surg Oncol. 2018;44(4):463–468. doi: 10.1016/j.ejso.2018.01.015Ito M, Kobayashi A, Fujita S, et al. Colorectal cancer study group of Japan Clinical Oncology Group. Urinary disfunction after rectal cancer surgery: results from a randomised trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or III lower rectal cancer (Japan Clinical Oncology Group Study. JCOG 0212. Eur J Surg Oncol. 2018;44(4):463–468. doi: 10.1016/j.ejso.2018.01.015Hirata Y, Norawa H, Kawai K, et al. The influence of neoadjuvant chemoradiation for lower rectal cancer on urinary function. Asian Journal of Surgery. 2019;42(3):731–739. doi: 10.1016/j.asjsur.2018.11.004Hirata Y, Norawa H, Kawai K, et al. The influence of neoadjuvant chemoradiation for lower rectal cancer on urinary function. Asian Journal of Surgery. 2019;42(3):731–739. doi: 10.1016/j.asjsur.2018.11.004Karisson L, Bock D, Asplund D, et al. Urinary dysfunction in patients with rectal cancer: a prospective cohort study. Colorectal Dis. 2020;22(1):18–28. doi: 10.1111/codi.14784Karisson L, Bock D, Asplund D, et al. Urinary dysfunction in patients with rectal cancer: a prospective cohort study. Colorectal Dis. 2020;22(1):18–28. doi: 10.1111/codi.14784Chill HH, Parnasa SY, Shussman N, et al. Urinary dysfunction in women following total mesorectal excision versus partial mesorectal excision for treatment of rectal cancer. BMC Women’s Health. 2021;21(237):1–6. doi: 10.1186/s12905-021.01381-7Chill HH, Parnasa SY, Shussman N, et al. Urinary dysfunction in women following total mesorectal excision versus partial mesorectal excision for treatment of rectal cancer. BMC Women’s Health. 2021;21(237):1–6. doi: 10.1186/s12905-021.01381-7Царьков П.В., Кочетков В.С., Ефетов С.К., и соавт. Использование интраоперационного нейромониторинга для определения вегетативных нервов малого таза при хирургическом лечении рака прямой кишки: обзор литературы и первичный опыт клиники. Сибирский онкологический журнал. 2019;18(2):58–64. doi: 10.21294/1814-4861-2019-18-2-58-64Tsarkov P.V., Kochetkov V.S., Efetov S.K., et al. Intraoperative neuromonitoring of pelvic autonomic nerves during surgical treatment of colorectal cancer: a review of the literature and the initial experience of our clinic. Siberian Journal of Oncology. 2019;18(2):58–64. (in Russ.). doi: 10.21294/1814-4861-2019-18-2-58-64Zhou M-W, Huang X-Y, Chen Z-Y, et al. Intraoperative monitoring of pelvic autonomic nerves during laparoscopic low anterior resection of rectal cancer. Journal Cancer Management and Research. 2019;11:411–417. doi: 10.2147/CMAR.S182181Zhou M-W, Huang X-Y, Chen Z-Y, et al. Intraoperative monitoring of pelvic autonomic nerves during laparoscopic low anterior resection of rectal cancer. Journal Cancer Management and Research. 2019;11:411–417. doi: 10.2147/CMAR.S182181Samara AA, Baloyiannis I, Perivoliotis K, et al. Intraoperative neuromonitoring in rectal cancer surgery: a systematic review and meta-analysis. Int J Colorectal Dis. 2021;36:1385–1394. doi: 10.1007/s00384.021.03884-zSamara AA, Baloyiannis I, Perivoliotis K, et al. Intraoperative neuromonitoring in rectal cancer surgery: a systematic review and meta-analysis. Int J Colorectal Dis. 2021;36:1385–1394. doi: 10.1007/s00384.021.03884-zYoo BE, Kye BH, Kim HJ, et al. Early removal of the urinary catheter after total or tumor-specific mesorectal excisionfor rectal cancer is safe. Dis Colon Rectum. 2015;58(7):686–691. doi: 10.1097/DCR.0000000000000386Yoo BE, Kye BH, Kim HJ, et al. Early removal of the urinary catheter after total or tumor-specific mesorectal excisionfor rectal cancer is safe. Dis Colon Rectum. 2015;58(7):686–691. doi: 10.1097/DCR.0000000000000386Аляев Ю.Г., Гаджиева З.К., Рапопорт Л.М., Казилов Ю.Б. Медикаментозное лечение симптомов нижних мочевых путей у мужчин. Роль уроселективности в выборе препарата. Андрология и генитальная хирургия. 2014;15(1):6–14. doi: 10.17650/2070-9781-2014-1-6-14Alyaev Yu.G., Gadzhieva Z.K., Rapoport L.M., Kazilov Yu.B. Drug treatment of lower urinary tract symptoms in males. Role uroselectivity in the choice of drug. Andrology and Genital Surgery. 2014;15(1):6–14. (In Russ.). doi: 10.17650/2070-9781-2014-1-6-14

The authors declare that there are no conflicts of interest present.