Disorders in urinary bladder micturition after rectal operations

作者：Zugor V^*; Miskovic I; Matzel K; Hohenberger W; Neuhuber W; Labanaris A; Schott G E

来源：Chirurg, 2010, 81(1): 56-60.

DOI：10.1007/s00104-009-1790-0

• Rectal carcinoma
• Urinary bladder functional disorder
• Pelvic nerve damage
• Rectal operation
• Neuromonitoring

Functional disorders of micturition after rectal resection were investigated on an in-house patient collective. Because the neuro-anatomy of the small pelvis is very complex, the aim of this study was to evaluate the incidence and form of disorders in micturition.
A total of 536 patients were operated on for a rectal carcinoma during the period 2000 to 2004 at the Surgical University Clinic in Erlangen. Patients with a recurrent tumor and patients who died during the study were excluded (140 patients). All patients were retrospectively questioned on the pre-operative and postoperative bladder function using a standard questionnaire.
The patient collective consisted of 167 males and 111 females with an average age of 63 years and a mean follow-up time of 2.6 years. Age (< 65 years versus > 65 years) was found not to play a significant role with respect to micturition (p > 0.05). Of the patients 20 already had a pollakisuria before the operation and 63 patients after the operation. Also 9 patients already had a nycturia before the operation and 55 after the operation. An imperative urgency to urinate was experienced by 9 patients before and 47 after the operation. Stress incontinence grade I was present in 21 patients before the operation, grade II in 4 patients and grade III in 1 patient. Of the patients 43 complained of stress incontinence grade I after the operation, 20 patients of a grade II and 15 of a grade III. The postoperative quality of life was assessed as very limited by 57 patients and moderately limited by 85.
Functional disorders of micturition after rectal resection in rectal cancer patients are commonly occurring complications which have received relatively little attention in the literature considering the clinical significance. Only few affected patients have received a urological treatment. Further studies are necessary, also experimental in nature, to understand the neuro-anatomy of the small pelvis in order to avoid intra-operative neurolesions as far as possible.

• 出版日期2010-1