Current status of research on short-term urogenital function after transanal total mesorectal excision and laparoscopic total mesorectal excision / 中华胃肠外科杂志

Thanks to the new surgical approach, transanal total mesorectal excision (taTME) has a better operative field exposure than laparoscopic-assisted total mesorectal excision (laTME), especially for male patients with obesity, pelvic stenosis or prostate hypertrophy. Nevertheless, whether the urogenital function and quality of life after taTME are better as compared to laTME requires further study. According to the existing studies, taTME and laTME are not significantly different in symptoms of the urology system for male patients, but some large sample clinical studies show that the incidence of urethral mechanical injury after taTME is higher. Unfortunately, there is no elaboration on that for females. The sexual function of male patients after taTME and laTME is both impaired. The sexual function of male patients will be relieved to different degrees over time, but there is no significant difference. Compared with laTME, taTME shows advantages in the sexual function for female patients. There is no significant difference in short-term urogenital system function between taTME and laTME at present. As a new surgical approach, the impact on urogenital system function after taTME is acceptable. However, whether there is a significant difference in urogenital function between taTME and laTME needs further research. In addition, functional results still need comprehensive evaluation, and preoperative baseline evaluation also needs to be enhanced. The functional evaluation for male and female should be carried out separately rather than confused. Questionnaire for evaluation of functional results also needs to be verified.

Research progress on urogenital function preservation in extralevator abdominoperineal resection / 中华胃肠外科杂志

Extralevator abdominoperineal excision (ELAPE) has been suggested to potentially improve oncological outcomes in advanced low rectal cancer patients. However, the urogenital function impairment as one of the main complications deteriorates the quality of life in these patients. The key point to prevent urogenital function impairment is to avoid autonomic nerve injury, including the superior and inferior hypogastric nerve plexus and neurovascular bundle. Three areas should be especially focused during surgery, including the posterolateral aspect of the prostate during the separation of the rectum from prostate, the lateral wall of ischioanal fossa and the area in front of anal canal. Previous presumption supposed that extended resection, though promoting oncologic outcomes, might lead to enlarged injury to surrounding vessels and nerves that deteriorated patients′ urogenital function. But recent studies show that postoperative urogenital function outcomes of rectal cancer patients who underwent ELAPE are not inferior to conventional APE after the induction of minimal invasive approaches including laparoscopic and robotic surgery. Their quality of life can be comparable with patients who underwent conventional APE, and are even better in some particular area. Moreover, as further improvement of ELAPE procedure has been made, the concept of individualized ELAPE addressed the importance of personalized surgical procedure based on tumor stage and location, dedicating to avoid injury to vessels and nerves through preserving more surrounding tissues. Urogenital function outcomes, as part of postoperative outcomes, get more and more attention in recent years. We review current studies on urogenital function after ELAPE from anatomy to clinical research, in order to raise surgeons′ attention of nerve preservation technique and to improve their understanding of ELAPE procedure.

The effects of the number of normal vaginal deliveries to the function of low urogenital system / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate if the number of normal vaginal deliveries influences lower urogenital system function and the incidence of incontinence. MATERIALS AND METHODS: The POP-Q (Pelvic Organ Prolapse Quantitation) examination was performed in 217 premenopausal women who visited our hospital for routine check up. They were asked to fill in the Bristol female lower urinary tract symptom (BFLUTS) and self-report questionnaire for fecal incontinence and constipation assessment questionnaires. Exclusion criteria included patients with a history of pelvic surgery, BMI >25, chronic lung disease, cardiovascular disease, colon disease or smoking. RESULTS: There was a significant difference between the vaginal delivery group and none vaginal delivery group in the point Aa, Ba, Ap, Bp and Tvl in POP-Q (P<0.05). The patients were classified into four groups (0, 1, 2,above 3) according to the number of vaginal deliveries, and the incidences of fecal incontinence were 4%, 29%, 32%, 26% in each group, respectively. The incidence of fecal incontinence was significantly lower (P<0.05) in those who did not deliver vaginally, while no difference was observed in the number of vaginal deliveries. The BFLUTS-IS (incontinence symptom) score was higher in the patients with higher number of vaginal deliveries (P<0.05). There were also more patients with sexual dysfunction as was shown by the BFLUTS-sex questionnaire (P<0.05) in those patients with higher number of vaginal deliveries. CONCLUSION: We observed that the number of vaginal delivery is significantly associated with the incidence of fecal and urinary incontinence, and also that it was a major cause of disorders of the pelvic floor and sexual dysfunction.