대한대장항문학회

Purpose : This study compares the sexual differences among rectal prolapse patients<br>regarding the clinical and the physiologic characteristics with emphasis on males. Methods :<br>The clinical data, functional status and operative records of 43 patients, who had completed<br>both clinical and functional evaluations were collected in a prospective database and were<br>analyzed according to sex. The functional status of the patients was evaluated by Wexner's<br>constipation score (0∼30), Wexner's incontinence score (0∼20), anorectal manometry, and<br>pudendal nerve terminal motor latency (PNTML). Results : The incidences of rectal prolapse<br>in males (n=22) and in females (n=21) were similar. The age of onset for males was lower<br>(mean standard deviation, 19.6 19.59 (50% in childhood) vs 52.0 20.75 years; p=0.001) and<br>the duration of symptoms was longer (31.5 19.87 vs 12.5 14.31 years; p＜0.001). Surgery in<br>males was most commonly performed during the sexually active years (51.2 16.34 vs 64.5<br>13.19; p=0.006). The incidence of mucosal prolapse in males was higher (10/22 vs 4/17;<br>p=0.065). The incidences and the severities of defecation difficulty in males and females were<br>similar (n=12, mean Wexner score=8.4 vs n=12, mean Wexner score=9.9; p=NS) but, the<br>incidences and the severities of fecal incontinence were lower in males (n=4, mean Wexner<br>score=4.3 vs n=17, mean Wexner score= 14.2; p＜0.001). The maximum resting pressure was<br>higher in males (39.2 21.46 vs 26.3 19.98 mmHg; p=0.049), and the maximum squeezing<br>pressure was better preserved (131.2 62.63 vs 67.5 37.99 mmHg; p＜0.001). No significant<br>difference existed in the PNTML. Female patients underwent abdominal resection rectopexy<br>(n=6), perineal rectosigmoidectomy with lavatoroplasty (n=11), and Delorme's procedure<br>(n=4), but all male patients preferred the perineal approach (rectosigmoidectomy with<br>lavatoroplasty (n=8), Delorme's procedure (n=14)) for fear of sexual dysfunction after the<br>abdominal approach. Conclusions : These findings suggest that the mechanism for developing<br>rectal prolapse in male and female may be different and that surgical treatment should be<br>tailored to the patient.<br>