Neurogenic bladder dysfunction after total mesorectumectomy

Abstract

AIM: to estimate the rate, causes and features of neurogenic bladder dysfunction in patients with rectal cancer after total mesorectumectomy.PATIENTS AND METHODS: the results of surgical treatment of 103 patients with rectal cancer were analyzed in the light of immediate and long-term outcomes, who underwent total mesorectumectomy using traditional (56-54.4%) and laparoscopic (47-45.6%) technologies. In 20 (19.4%) of 103 patients, the course of the immediate postoperative period was complicated by the development of neurogenic bladder dysfunction. In order to study the frequency of neurogenic bladder dysfunction depending on the technique of mesorectumectomy, the patients were divided into 2 groups. Group 1 included 9 patients who underwent laparoscopic total mesorectumectomy. Group 2 included 11patients who underwent traditional (open) mesorectumectomy.RESULTS: the study of the functional state of the bladder according to the flowmetric indicators revealed that the frequency of development of postoperative bladder dysfunction has a gender dependence. The frequency of neurogenic bladder dysfunction was 25% in men and 10,7% in women. It is shown that during 1 week and 6 months after surgery, the average urination rate tends to increase in women and decrease in men, regardless of the technique of total mesorectumectomy. In both groups, there was not a statistically significant decrease in the maximum volumetric velocity in both men and women within 6 months after surgery. At the same time, during this period, there was a decrease in the average rate of urination only in men, regardless of the technique of total mesorectumectomy. And in women, this indicator remained unchanged or slightly increased.CONCLUSION: it is shown that a complex system of therapeutic measures, including drug stimulation of the detrusor and urethral sphincter, repeated catheterization of the bladder, as well as epicystostomy performed according to indications, allows adequate correction of bladder dysfunction after total mesorectumectomy in patients with rectal cancer.