Functional urological complications after colo-rectal cancer surgery

Colo-rectal cancer is a common disease. The Incidence is estimated as 15.7 (male) and 10.4 (female population) / 100.000. The number of patients undergoing curative colorectal surgery has increased, due to the introduction of new surgical strategies, such as total excision of the mesorectum (TME), and confirmation that short surgical resection margins are acceptable.1 Surgical options for patients with cancer of the lower third of the rectum include anterior resection with anastomosis (AR), and abdomino-perineal resection (APR). Both procedures have a significant impact on the patients’ quality of life, the stoma itself for obvious reasons, but also the presence of a low anastomosis, which can disrupt the normal rectal function. Urological dysfunction can also result from low rectal surgery. Urological dysfunction detected immediately after surgery requires correct diagnosis and appropriate treatment in order to avoid permanent impairment. The incidence of low urinary tract symptoms after colorectal surgery is between 20 and 40%, higher in male patients (M:F = 4:1) due to anatomical differences or the presence of benign prostate enlargement, which increase the possibility of neurological dysfunction in men. On the other hand, multiparous female patients can present with significant pelvic floor damage. Nevertheless, postoperative symptoms are often transient and usually only 10% of patients require medical or surgical treatment. The aim of this study is to assess the incidence and magnitude of urological functional damage, in particular regarding the lower urinary tract, following surgery for rectal cancer. To this purpose, we reviewed the international literature available on this subject. We searched the Medline for English language papers relating to human studies with no time limits based on the following search keywords: rectal neoplasm, rectal neoplasia, rectal adenocarcinoma, rectal cancer, colo-rectal cancer, urological dysfunction, functional urological dysfunction, voiding dysfunction, bladder dysfunction and low urinary tract symptoms.