Change in Potency following Rectal Cancer Surgery

Paick, Jae Seung; Oh, Seung Joon; Park, Jae Gahb; Choe, Kuk Jin; Kim, Seung Hyup

Abstract

The frequency of sexual dysfunction from rectal cancer operation has been reported with wide range from 8 to 86%. We have performed prospective study to analyze the cause of sexual dysfunction after operation in rectum which is anatomically adjacent to cavernous nerve and artery The study was done from April 1991 to March 1992 with 26 patients who were neurologically normal before the radical rectal surgery. To study intraoperative vascular damage, we performed duplex doppler sonography of penile arteries preoperatively and on tenth postoperative day. To study neurologic insult urodynamic study was performed preoperatively, tenth postoperative day and postoperative sixth month, and subjective sexual history was obtained preoperatively and postoperative sixth month. There was no evidence of change in the diameter and peak velocity of cavernous artery on penile duplex sonography and penile rigidity, implying no vascular damage. Fourteen patients (53%) complained of sexual dysfunction in postoperative sixth month. Subjective sexual dysfunction showed no correlation with age, stage, mode of operation, tumor size, tumor location from anal verge and intraluminal position of the tumor. We couldn't find any association between postoperative decreased libido and decreased self-esteem from stoma, which confirms that psychologic cause does not seem to ascribe to erectile dysfunction. Patients with neurologic deficit were 21(81%) on tenth postoperative day, but only 4(17 %) out of 23 who were followed up to postoperative sixth month. This suggests that recovery of sexual dysfunction was delayed or impossible, compared with rapid recovery of bladder dysfunction. This also suggests additional intraoperative nerve damage along cavernous nerve pathway. In conclusion, sexual dysfunction after rectal cancer operation was not caused by vascular damage nor psychologic etiology. Nerve damage is rather highly suggested, but there was no correlation with stage and mode of operation.