대한대장항문학회

<b>Purpose:</b> The aim of this study was to assess the safety of TME with pelvic autonomic nerve preservation in male rectal cancer patients in terms of voiding and sexual function.<br><br><b>Methods:</b> We performed uroflowmetry using Urodyn (Dantec, Denmark) and a standard questionnaire employing the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) pre- and postoperatively in 68<br>male<br>rectal cancer patients.<br><br><b>Results:</b> There were significant differences of mean maximal flow rate and voided volume before and after surgery (18.9±5.7 vs 13.7±7.0, 240±91.9 vs 143±78, P＜0.05, P＜0.05), respectively. But, there was no difference of residual<br>volume<br>before and after surgery (4.4±2.6 vs 8.1±4.4, P＞0.05). The total IPSS (International Prostate Symptom Score) was increased after surgery from 6.2±5.8 to 9.8±5.9 (P＜0.05). There were no changes of score for one of each seven IPSS items in<br>from<br>49<br>patients (73.5 percent) to 61 patients (89.7 percent). Five IIEF (International Index of Erectile Function) domain score (erectile function, intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction) was statistically<br>decreased<br>after surgery (18.2±9.3 vs 13.5±9.0, 8.4±4.2 vs. 4.4±2.9, 5.8±2.9, vs. 4.4±2.9, 6.1±2.4 vs. 4.8±2.0, 6.1±2.2 vs. 4.5±2.3, P＜0.05, respectively. Erection was possible in 55 patients (80.9 percent), but penetration ability was possible<br>in<br>51<br>patients (75 percent). Complete inability for erection and intercourse was observed in 3 patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). IIEF domains such as sexual desire and overall satisfaction were<br>markedly<br>decreased in 39 patients (57.4 percent), 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that over 60 years (sexual desire: P=0.019), within 6 months (erectile<br>function:<br>P=0.04, intercourse satisfaction: P=0.011, orgasmic function: P=0.03), lower rectal cancer (erectile function: P=0.02, intercourse satisfaction: P=0.036, orgasmic function: P=0.027) were significant factors.<br><br><b>Conclusions:</b> TME with pelvic autonomic nerve preservation technique showed a safety and comparable data in preserving sexual and voiding function. The IPSS and IIEF questionnaire were useful and more investigative in assessing urinary and<br>sexual<br>function.<br>