gms | German Medical Science

Aim: Functional bladder outlet obstructions after rectal resection were examined within our patient collective. With neuroanatomy being very complex within the pelvis minor, our study not only aims at the incidence, but also at the form and genesis of bladder outlet obstructions.

Material and methods: From 2000-2004, 536 patient were surgically treated for rectal carcinoma in the University Hospital Erlangen. Patients with tumor recrudescence and patients who have since died were not considered in this study. All patients were asked in retrospect about their bladder function before and after surgery, using standardized questionnnaires. With a 70% response 243 questionnaires could eventually be analyzed, using the SPSS (Statistical Product and Service Solutions) computer program. Univariate analysis involved Chi squared test as well as Mann-Whitney-U test.

Results: Our patient collective consisted of 148 men and 95 women. 20 patients had pollakiuria before surgery, 63 after surgery. Preoperatively, 9 patients complained of nocturia; postoperatively, 55 patients did so. 9 patients experienced imperative urination before surgery; after surgery the number increased to 47. Preoperatively, stress incontinence occured in 21 patients as first degree, in 4 patients as second degree, and in one patient as third degree. Postoperatively, these numbers climbed to 43, 20 and 15 patients, respectively. Postoperative quality of life was characterized as highly restricted by 57 patients and moderately restricted by 85 patients. Only 33 of 243 patients evalutated accepted urological support. 184 patients did not experience any complications during or after operation, 59 patients had various complications of different severity (11 patients suffered from thrombosis, 5 from embolism, 35 from impaired woundhealing, 8 from fistula).

Conclusion: Functional bladder outlet obstruction after rectal resection are common complications with patients with rectal carcinoma. Yet, considering their clinical relevance, they have been unsufficiently described in literature. Only few patients have accessed urological support. More studies, also of an experimental nature, are required to better understand the neuroanatomy of the pelvis minor, and also to avoid nerve lesions during operation.