Abstract：
Urogenital dysfunction is a common sequela following total mesorectal excision for rectal cancer. This prospective study analyzed potential risk factors and investigated the impact of pelvic intraoperative neuromonitoring.
Included were 85 patients undergoing total mesorectal excision for rectal cancer, 43 under the control of pelvic intraoperative neuromonitoring. Urogenital function was assessed with validated questionnaires within a 2-year follow-up period. Potential risk factors were identified by multivariate analysis.
Overall, approximately one-third of treated patients suffered from new onset of urinary dysfunction. Initially, half of the sexually active patients were affected by sexual dysfunction; after 2 years, almost three quarters were affected. In the pelvic intraoperative neuromonitoring group, urinary and sexual dysfunction rates including minor and major disturbances were significantly lower (2-year follow-up 20% vs. 51% (p = 0.004) and 56% vs. 90% (p = 0.010)). Throughout the survey, non-performance of pelvic intraoperative neuromonitoring was found to be an independent risk factor. Neoadjuvant chemoradiotherapy was identified as an independent predictor for urogenital dysfunction in the further course one and 2 years after surgery.
Pelvic intraoperative neuromonitoring is associated with significantly lower rates of urinary and sexual dysfunction in the short and long run, whereas neoadjuvant chemoradiotherapy has a negative impact only in the long run.
Included were 85 patients undergoing total mesorectal excision for rectal cancer, 43 under the control of pelvic intraoperative neuromonitoring. Urogenital function was assessed with validated questionnaires within a 2-year follow-up period. Potential risk factors were identified by multivariate analysis.
Overall, approximately one-third of treated patients suffered from new onset of urinary dysfunction. Initially, half of the sexually active patients were affected by sexual dysfunction; after 2 years, almost three quarters were affected. In the pelvic intraoperative neuromonitoring group, urinary and sexual dysfunction rates including minor and major disturbances were significantly lower (2-year follow-up 20% vs. 51% (p = 0.004) and 56% vs. 90% (p = 0.010)). Throughout the survey, non-performance of pelvic intraoperative neuromonitoring was found to be an independent risk factor. Neoadjuvant chemoradiotherapy was identified as an independent predictor for urogenital dysfunction in the further course one and 2 years after surgery.
Pelvic intraoperative neuromonitoring is associated with significantly lower rates of urinary and sexual dysfunction in the short and long run, whereas neoadjuvant chemoradiotherapy has a negative impact only in the long run.
摘要：
泌尿生殖功能障碍是直肠癌全直肠系膜切除术后的常见后遗症。这项前瞻性研究分析了潜在的危险因素，并调查了盆腔术中神经监测的影响。
包括85例直肠癌全直肠系膜切除术患者，43控制下盆腔术中神经监测。在2年的随访期内，使用经过验证的问卷评估了泌尿生殖功能。通过多变量分析确定潜在的危险因素。
总的来说，大约三分之一的接受治疗的患者患有新的泌尿功能障碍。最初，一半的性活跃患者受到性功能障碍的影响；2年后，近四分之三受到影响。在盆腔术中神经监测组中，包括轻微和主要障碍在内的泌尿和性功能障碍发生率显着降低（2年随访20％vs.51%(p=0.004)和56%与90%(p=0.010))。在整个调查中,未进行盆腔术中神经监测是独立的危险因素.在术后1年和2年的进一步治疗中，新辅助放化疗被确定为泌尿生殖系统功能障碍的独立预测因子。
盆腔术中神经监测与短期和长期的泌尿和性功能障碍发生率显著降低相关，而新辅助放化疗仅在长期具有负面影响.
包括85例直肠癌全直肠系膜切除术患者，43控制下盆腔术中神经监测。在2年的随访期内，使用经过验证的问卷评估了泌尿生殖功能。通过多变量分析确定潜在的危险因素。
总的来说，大约三分之一的接受治疗的患者患有新的泌尿功能障碍。最初，一半的性活跃患者受到性功能障碍的影响；2年后，近四分之三受到影响。在盆腔术中神经监测组中，包括轻微和主要障碍在内的泌尿和性功能障碍发生率显着降低（2年随访20％vs.51%(p=0.004)和56%与90%(p=0.010))。在整个调查中,未进行盆腔术中神经监测是独立的危险因素.在术后1年和2年的进一步治疗中，新辅助放化疗被确定为泌尿生殖系统功能障碍的独立预测因子。
盆腔术中神经监测与短期和长期的泌尿和性功能障碍发生率显著降低相关，而新辅助放化疗仅在长期具有负面影响.
