Skip to main content
Top
Published in: International Journal of Colorectal Disease 12/2011

01-12-2011 | Original Article

Male sexual dysfunction after rectal cancer surgery

Authors: Yuji Nishizawa, Masaaki Ito, Norio Saito, Takanori Suzuki, Masanori Sugito, Toshiyuki Tanaka

Published in: International Journal of Colorectal Disease | Issue 12/2011

Login to get access

Abstract

Purpose

The aims of the study were to determine the extent of male sexual dysfunction after surgical treatment of rectal cancer and to examine the outcome of postoperative treatment with sildenafil.

Methods

A prospective study was performed in patients who underwent attempted curative total mesorectal excision (TME) for low rectal cancers. Sexual function scores were determined by questionnaire preoperatively and at 3 and 12 months postoperatively. Outcomes were examined in patients who were sexually active preoperatively.

Results

From 2000 to 2007, 207 patients underwent TME at our institution, of whom 49 (24%) were sexually active preoperatively. Erectile dysfunction and ejaculatory problems were present in 80% and 82%, respectively of the 49 patients at 3 months postoperatively, and in 76% and 67%, respectively at 12 months. Lateral lymph node dissection was a strong risk factor for postoperative sexual dysfunction. The impotency rate was 37% and 47% of patients were unable to ejaculate. Sildenafil was administered to 16 patients who requested the drug during follow-up, and sexual dysfunction was improved in 11 of these patients (69%).

Conclusion

Sexual dysfunction occurs frequently after rectal cancer treatment and is mainly caused by surgical damage in lateral lymph node dissection. Sildenafil may be effective for the treatment of sexual dysfunction.
Literature
1.
go back to reference Kapiteijn E, van de Velde CJ (2002) The role of total mesorectal excision in the management of rectal cancer. Surg Clin North Am 82(5):995–1007PubMedCrossRef Kapiteijn E, van de Velde CJ (2002) The role of total mesorectal excision in the management of rectal cancer. Surg Clin North Am 82(5):995–1007PubMedCrossRef
2.
go back to reference Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69(10):613–616PubMedCrossRef Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69(10):613–616PubMedCrossRef
3.
go back to reference Banerjee AK (1999) Sexual dysfunction after surgery for rectal cancer. Lancet 353(9168):1900–1902PubMedCrossRef Banerjee AK (1999) Sexual dysfunction after surgery for rectal cancer. Lancet 353(9168):1900–1902PubMedCrossRef
4.
go back to reference Lange MM, Marijnen CA, Maas CP, Putter H, Rutten HJ, Stiggelbout AM, Meershoek-Klein Kranenbarg E, van de Velde CJ, Cooperative clinical investigators of the D (2009) Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer 45(9):1578–1588. doi:10.1016/j.ejca.2008.12.014 CrossRef Lange MM, Marijnen CA, Maas CP, Putter H, Rutten HJ, Stiggelbout AM, Meershoek-Klein Kranenbarg E, van de Velde CJ, Cooperative clinical investigators of the D (2009) Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer 45(9):1578–1588. doi:10.​1016/​j.​ejca.​2008.​12.​014 CrossRef
5.
7.
go back to reference Pocard M, Zinzindohoue F, Haab F, Caplin S, Parc R, Tiret E (2002) A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer. Surgery 131(4):368–372PubMedCrossRef Pocard M, Zinzindohoue F, Haab F, Caplin S, Parc R, Tiret E (2002) A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer. Surgery 131(4):368–372PubMedCrossRef
9.
go back to reference Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J (1996) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182(6):495–502PubMed Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J (1996) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182(6):495–502PubMed
10.
go back to reference Enker WE (1992) Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 127(12):1396–1401PubMed Enker WE (1992) Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 127(12):1396–1401PubMed
11.
go back to reference Porter GA, Soskolne CL, Yakimets WW, Newman SC (1998) Surgeon-related factors and outcome in rectal cancer. Ann Surg 227(2):157–167PubMedCrossRef Porter GA, Soskolne CL, Yakimets WW, Newman SC (1998) Surgeon-related factors and outcome in rectal cancer. Ann Surg 227(2):157–167PubMedCrossRef
13.
go back to reference Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P, Guillou PJ (2005) Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg 92(9):1124–1132. doi:10.1002/bjs.4989 PubMedCrossRef Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P, Guillou PJ (2005) Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg 92(9):1124–1132. doi:10.​1002/​bjs.​4989 PubMedCrossRef
14.
go back to reference Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49(6):822–830PubMedCrossRef Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49(6):822–830PubMedCrossRef
15.
go back to reference Hendren SK, O'Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, Macrae HM, Gryfe R, McLeod RS (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242(2):212–223PubMedCrossRef Hendren SK, O'Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, Macrae HM, Gryfe R, McLeod RS (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242(2):212–223PubMedCrossRef
18.
go back to reference Hojo K, Sawada T, Moriya Y (1989) An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 32(2):128–133PubMedCrossRef Hojo K, Sawada T, Moriya Y (1989) An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 32(2):128–133PubMedCrossRef
20.
go back to reference Kinugasa Y, Murakami G, Uchimoto K, Takenaka A, Yajima T, Sugihara K (2006) Operating behind Denonvilliers' fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: A histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum 49(7):1024–1032. doi:10.1007/s10350-006-0557-7 PubMedCrossRef Kinugasa Y, Murakami G, Uchimoto K, Takenaka A, Yajima T, Sugihara K (2006) Operating behind Denonvilliers' fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: A histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum 49(7):1024–1032. doi:10.​1007/​s10350-006-0557-7 PubMedCrossRef
21.
go back to reference Lindsey I, George B, Kettlewell M, Mortensen N (2002) Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease. Dis Colon Rectum 45(6):727–732PubMedCrossRef Lindsey I, George B, Kettlewell M, Mortensen N (2002) Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease. Dis Colon Rectum 45(6):727–732PubMedCrossRef
23.
go back to reference Milone M, DiBaise JK (2005) A pilot study of the effects of sildenafil on stool characteristics, colon transit, anal sphincter function, and rectal sensation in healthy men. Dig Dis Sci 50(6):1005–1011PubMedCrossRef Milone M, DiBaise JK (2005) A pilot study of the effects of sildenafil on stool characteristics, colon transit, anal sphincter function, and rectal sensation in healthy men. Dig Dis Sci 50(6):1005–1011PubMedCrossRef
24.
go back to reference Fritz E, Hammer J, Schmidt B, Eherer AJ, Hammer HF (2003) Stimulation of the nitric oxide-guanosine 3', 5'-cyclic monophosphate pathway by sildenafil: effect on rectal muscle tone, distensibility, and perception in health and in irritable bowel syndrome. Am J Gastroenterol 98(10):2253–2260. doi:10.1111/j.1572-0241.2003.07661.x PubMed Fritz E, Hammer J, Schmidt B, Eherer AJ, Hammer HF (2003) Stimulation of the nitric oxide-guanosine 3', 5'-cyclic monophosphate pathway by sildenafil: effect on rectal muscle tone, distensibility, and perception in health and in irritable bowel syndrome. Am J Gastroenterol 98(10):2253–2260. doi:10.​1111/​j.​1572-0241.​2003.​07661.​x PubMed
Metadata
Title
Male sexual dysfunction after rectal cancer surgery
Authors
Yuji Nishizawa
Masaaki Ito
Norio Saito
Takanori Suzuki
Masanori Sugito
Toshiyuki Tanaka
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 12/2011
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-011-1247-z

Other articles of this Issue 12/2011

International Journal of Colorectal Disease 12/2011 Go to the issue