Comparison of Urogenital Functions after Transanal and Laparoscopic Total Mesorectal Excision

Urogenital dysfunction after rectal surgery is associated with neurovascular bundle (NVB) injury. We compared urinary and sexual functions after transanal total mesorectal excision (taTME) and laparoscopic total mesorectal excision (laTME), and analysed the impact of the differences in NVB injuries on the functional outcomes of these treatments. Overall, 187 patients with rectal cancer who underwent taTME (n = 94) or laTME (n = 93) at the Shengjing Hospital of China Medical University between March 2018 and June 2021 were included. Ninety-seven patients (taTME, n = 52; laTME, n = 45) with NVB injuries were classified as bleeding subgroups and the others as non-bleeding subgroups. Urinary function was compared 6 and 12 months postoperatively using the International Prostate Symptom Score (IPSS). Sexual function was compared 12 months postoperatively using the five-item International Index of Erectile Function (IIEF-5). The IPSS of all groups at 6 months postoperatively was higher than that preoperatively. All postoperative scores in the bleeding subgroup of the taTME group were significantly higher than the preoperative scores. The bleeding subgroup of the taTME group had higher IPSS and significantly lower IIEF-5 scores than the non-bleeding subgroup of the taTME group and the bleeding subgroup of the laTME group postoperatively. The IIEF-5 scores of all groups at 12 months postoperatively were lower than those preoperatively. This study confirmed impaired urinary and sexual functions after taTME and laTME, and patients with NVB injuries in the taTME group had worse urinary and sexual dysfunction.