Functional Results After Nerve-Sparing, Sphincter Preserving Rectal Cancer Surgery: Patient-Reported Outcomes of Sexual and Urinary Dysfunction

There is an ongoing unmet need of early identification and discussion regarding the sexual and urinary dysfunction in the peri-operative period to improve the quality of life (QoL), particularly in young rectal cancer survivors. Retrospective analysis of prospectively maintained database was done. Male patients less than 60 years who underwent nerve preserving, sphincter sparing rectal cancer surgery between January 2013 and December 2019, were screened. International Index of Erectile Function (IIEF-5) questionnaire was given to assess erectile dysfunction (ED). Patients were asked questions regarding their sexual and urinary function from the EORTC-QL CRC 38 questionnaire, and responses were recorded. Patients were also asked to report any retrograde ejaculation in post-operative period. Sixty-two patients were included in the study. Fifty-four patients (87.1%) received a diversion stoma. Sixteen patients (29.6%) felt stoma was interfering with their sexual function. Six patients (9.7%) reported retrograde ejaculation. Only 5 patients (8.06%) had moderate to severe ED, and the rest had none to mild ED. On univariate and multivariate analysis, only age predicted the development of clinically significant ED. Ten patients (16.1%) had significantly reduced sexual urges, and 23 patients (37.1%) had significant decrease in sexual satisfaction after surgery. Five patients (8.06%) reported having minor urinary complaints. No patient reported having major complaint pertaining to urinary health. While long-term urinary complaints are infrequent, almost half the patient suffered from erectile dysfunction in some form. There is a weak but significant association of age and ED. Follow-up clinic visits provide an ideal opportunity to counsel patients and provide any medical intervention, when necessary.