The researchers could not demonstrate that close rectal dissection significantly protects the patient from impotence, compared with operating in the anatomical mesorectal plane.
|Rate of complete and partial impotence:|
Close rectal dissection:
2.2% and 13.5%
4.5% and 13.3%
|Diseases of the Colon and Rectum|
The team determined whether close rectal dissection is more protective of the pelvic sexual nerves than mesorectal dissection, and reported their findings in June's Diseases of the Colon and Rectum.
Close rectal dissection is a surgical technique used by some surgeons in inflammatory bowel disease (IBD). It is performed within the mesorectum, close to the rectal muscle wall, with the aim of minimizing damage to the pelvic sexual nerves. Other surgeons dissect in the more anatomical mesorectal plane.
Patients undergoing surgery for IBD were entered prospectively into a database. Male patients were mailed a standardized validated urologic impotence questionnaire: the International Index of Erectile Function.
There was an 81% response rate.
The researchers found that 6 of 156 assessable patients were totally impotent (3.8%). They were all in the 50-year-old to 70-year-old age group. There was no impotence in patients younger than 50 years old.
Some 21 patients complained of minor diminution of erectile function (13.5%), where sexual activity was still possible.
There was found to be no statistical difference in the rate of complete (2.2% vs. 4.5%) or partial (13.5% vs. 13.3%) impotence between close rectal and mesorectal dissection.
No ejaculatory difficulties were reported.
The time elapsed since surgery ranged from 2.7 months to 192.7 months, with a median of 74.5 months.
Author Ian Lindsey, of the Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, said on behalf of the group, "Rectal excision for IBD can be conducted with low rates of impotence. Minor degrees of erectile dysfunction may be more common than currently recognized."
"We could not demonstrate that close rectal dissection significantly protects the patient from impotence, compared with operating in the anatomical mesorectal plane," he added.
"Age appears to be the most important risk factor for postoperative impotence," he concluded.