Neurogenic bladder dysfunction after total mesorectumectomy

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

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: 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: 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.

1. 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.).

2. 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.21395

3. Mannucci 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.v25i21.2565

4. Sung 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.21660

5. Azimov 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: 10.33878/2073-7556-2019-18-3-41-48

6. Sidorov 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/onkolog202090415

7. Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1449–1482. doi: 10.1016/s0140-6736(86)91510-2

8. Deng 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.1671-0274.2019.12.009

9. Kim 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.2021.62.3.187

10. Fang 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.0000000000001358

11. Kim 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.2015.06.012

12. Tang JH, Ding PR. Autonomic nerve preserving in laparoscopic total mesorectal excision. J Xiangyua Med. 2017;2:43. doi: 10.21037/jxym.2017.04.03

13. Chew 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/gow023

14. Kokelaar RF, Evans MD, Davies M, et al. Locally advanced rectal cancer: management callenges. Onco Targets Ther. 2016;9:6265–6272. doi: 10.2147/0TTS100806

15. Kumar 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: 10.20517/2574-1225.2018.26

16. Chill 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/s12905-021-013381-7

17. George 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_17

18. Dulskas 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-y

19. Qiao 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.2015.0479

20. Ha 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.2021.100.2.109

21. Ito 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.2018.01.015

22. Hirata 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.2018.11.004

23. Karisson 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.14784

24. Chill 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/s12905-021.01381-7

25. Tsarkov 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: 10.21294/1814-4861-2019-18-2-58-64

26. Zhou 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.S182181

27. Samara 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-z

28. Yoo 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.0000000000000386

29. Alyaev 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