Persistent vesicourethral dysfunction following radical surgery for rectal carcinoma: urodynamic features and potential abatement with modified sphincterotomy (radical transurethral resection of the prostate).:

Persistent vesicourethral dysfunction following radical surgery for rectal carcinoma: urodynamic features and potential abatement with modified sphincterotomy (radical transurethral resection of the prostate).
Int J Urol. 1998 Jan;5(1):39-43
Authors: Mitsui T, Shinno Y, Kobayashi S, Matsuura S, Shibata T, Ameda K, Koyanagi T
BACKGROUND: Vesicourethral function returns after radical rectal surgery during the first year but rarely progresses after 1 year. We examined the urodynamics of patients whose voiding dysfunction remained after 1 year, and treated several with a modified sphincterotomy procedure similar to radical transurethral resection of the prostate. METHODS: We analyzed the urodynamic features of vesicourethral dysfunction in 16 male patients with persistent voiding dysfunction for more than 1 year following radical surgery for rectal carcinoma. Seven patients elected to undergo radical transurethral resection of prostate (radical TUR-P) for the relief of their persistent voiding dysfunction. RESULTS: The mean bladder volume at the first desire to void was 210 mL, the mean maximal bladder capacity was 343 mL, and the mean vesical compliance (Cves) was 27.1 mL/cm H2O. All patients demonstrated either vesical denervation supersensitivity (Vds) or uninhibited contraction. The mean maximal urethral closure pressure was 43.9 cm H2O, and urethral denervation supersensitivity was found in 77.8% (7/9), and sphincter dyssynergia in 66.7% (6/9) of patients. After radical TUR-P, 5 patients became free from the use of self-catheterization, 1 patient had a reduced residual urine rate, and 1 patient was unchanged, but no patient noted a change in urinary control. CONCLUSION: Urethral dysfunction after radical rectal surgery was caused by failure of the bladder to empty along with an underactive detrusor. Radical TUR-P was effective in restoring voiding function in a selected group of these patients.
PMID: 9535599 [PubMed – indexed for MEDLINE]