Sexual Function Impact of Anterior Rectal Resection: A Retrospective Study

Abstract

Introduction: As the surgical technique and the medical support care progresses, que lifespan of our patients increases, therefore aspects such as the quality of life after invasive treatments have been more and more valued. The anterior rectal resection (ARR) is an option for patients with certain pathologies localized to the rec- tum (for instance adenocarcinoma). This procedure has the risk of resulting in important morbidities, not only gastrointestinal, but also urological, such as incontinence and sexual dysfunction (e.g. erectile dysfunction [ED]).

Our objective was to assess the impact in erectile and sexual function of patients submitted to anterior rectal resection.

Materials and Methods: It was conducted a cross-sectional study, including all patients of the masculine sex, that went through ARR between November 2018 and September 2019 in the Centro Hospitalar e Universitário de Coimbra (CHUC) (n=43). The population presented a median age of 66.1±9.9 years old (ages between 29 and 90). Telephone interviews were carried out and a questionnaire about sexual performance and erectile function before surgery, as well as after the procedure, was performed. For this, we used the International Index of Erectile Function 5 (IIEF-5) with a cut-off of <22 to define erectile dysfunction. Verbal consent was obtained from all patients.

Results: Of the 43 patients, only 32 met the inclusion criteria and were included in the study. Before surgery, 26 participants (81,3%) said to be sexually active, with the sample presenting an average score in the IIEF-5 of 18.7±6.4. After surgery, 16 patients (50%), stated to be sexually active, with the sample presenting an average score in the IIEF-5 of 11.1±6.2. The prevalence of ED (IIEF-5 < 22) in the sample before the procedure was 53,1%, with this number increasing to 90% after surgery. Twenty three patients admitted a decrease in their erectile function. Of them, 4 (17.3%) stated mild improvement in function over time, with the remaining patients denying changes since surgery. A negative impact in the erectile function of patients submitted to ARR was found (p<0.05). Ten patients sexually active before surgery never resumed sexual activity after the procedure. Among the subjects that reported a decrease in erectile function, only 4 spoke about it with a healthcare professional and 3 were referred to an urologist. None of the patients referred to have been actively asked about the impact of surgery in its sexual function during the postoperative follow-up.

Conclusion: This study demonstrated a clear negative impact in erectile function of patients submitted to ARR. We stress the importance of surveilling the impact in erectile function in every man during the postoperative surveillance of ARR. We believe that a timely and adequate sexual rehabilitation is possible, allowing an improvement in the quality of life of these individuals.