Purpose: This study was designed to investigate sexual and urinary dysfunction in women who underwent rectal cancer excision, and the influence of tumor and treatment variables on long-term outcomes.
Methods: Data were prospectively collected on 295 women who underwent rectal cancer excision at a tertiary referral colorectal center from 1998 to 2006. Sexual and urinary function was assessed preoperatively and at intervals up to five years after surgery. Functional outcomes were assessed by using univariate and multivariate regression analysis, chi-squared test for trend, or Kruskal-Wallis test.
Results: The mean age of the patients was 60.9 years. Anterior resection was performed in 222 patients (75.2 percent) and abdominoperineal resection in 73 patients (24.7 percent). Patients who underwent abdominoperineal resection were less sexually active (25 vs. 50 percent; P = 0.02) and had a lower frequency of intercourse than anterior resection patients at one year after surgery (anterior resection, 3 (0-5) (median interquartile range); abdominoperineal resection 0 (0-4); P = 0.029). The frequency of intercourse improved over time for abdominoperineal resection (4 months, 0 (0-0) median interquartile range; 5 years, 3 (0.25-4) median interquartile range; P = 0.028). Abdominoperineal resection was associated with increased dyspareunia (odds ratio, 5.75; 95 percent confidence interval (CI), 1.87-17.6; P = 0.002), urinary urgency (odds ratio, 8.52; 95 percent CI, 2.81-25.8; P < 0.001), incontinence (odds ratio, 2.41; 95 percent CI, 1.11-5.26; P = 0.026), poor stream (odds ratio, 5.64, 95 percent CI, 2.55-12.5; P <or= 0.001), and urinary retention (odds ratio, 11.7; 95 percent CI, 4.15-32.9; P < 0.001). Women who underwent radiotherapy had a 4.68-fold increase in dyspareunia (95 percent CI, 1.84-11.9; P = 0.001). Intra-abdominal sepsis was associated with decreased ability to achieve arousal (odds ratio, 0.085; 95 percent CI, 0.008-0.958; P = 0.046).
Conclusions: Abdominoperineal resection, radiotherapy, intra-abdominal sepsis, and age 65 years or older are associated with significant impairments in female urinary and sexual outcomes after rectal cancer excision. Sexual and urinary outcomes should be considered when planning treatment for patients with rectal cancer.