Anorectal function and symptoms 6 months after robot-assisted laparoscopic radical prostatectomy: a single-center study
DOI:
https://doi.org/10.2340/sju.v59.35396Keywords:
RALP, Prostatectomy, fecal incontinence, bowel, anorectal functionAbstract
Introduction: Robot-assisted laparoscopic radical prostatectomy (RALP) is a common procedure for the treatment of localised prostate cancer. Anorectal symptoms such as fecal incontinence (FI), rectal urgency or disturbed defecation have been reported after the operation. Anorectal function is dependent on the integrity of anal and pelvic nerves and muscles, rectal sensory function as well as rectal reservoir function.
The aim of this study was to investigate the potential influence of RALP on anorectal physiological function and bowel symptoms.
Materials and Methods: In this pilot study, 29 patients with localised prostate cancer scheduled for RALP were included. Anorectal physiology was used to measure rectal sensitivity and reservoir function as well as anal sphincter pressures. Bowel symptoms were measured by a bowel function questionnaire and a 2-week bowel function diary. Measurements were done before the operation and repeated at 6 months after the operation.
Results: The study observed a significant postoperative increase in rectal sensory threshold for rectal balloon distention, from 20 to 40 mmHg, P < 0.001. This change is indicative of a decrease in rectal sensation after RALP. There were no other statistical significant differences in any of the physiological tests performed. Importantly, there was no change in any of the bowel symptoms after surgery.
Conclusion: This study showed that RALP may lead to impaired rectal sensory function. This finding did not, however, seem to have any influence on the patients´ postoperative clinical bowel function.
Downloads
References
Regionala cancercentrum i samverkan. Nationellt vårdprogram för prostatacancer; vers-ion 8.1. [Internet]. Stockholm: Regionala cancercentrum i samverkan; 2023. [citerad 2023-12-08]. https://kunskapsbanken.cancercentrum.se/diagnoser/prostatacancer/.
Rassweiler J, Frede T, Seemann O, et al. Telesurgical laparoscopic radical prostatectomy. Initial experience. Eur Urol. 2001;40(1):75–83.
https://doi.org/10.1159/000049752 DOI: https://doi.org/10.1159/000049752
Laviana AA, Williams SB, King ED, et al. Robot assisted radical prostatectomy: the new standard? Minerva Urol Nefrol. 2015;67(1):47–53.
Tutolo M, Bruyneel L, Van der Aa F, et al. A novel tool to predict functional outcomes after robot-assisted radical prostatectomy and the value of additional sur-gery for incontinence. BJU Int. 2021;127(5):575–584.
https://doi.org/10.1111/bju.15242 DOI: https://doi.org/10.1111/bju.15242
Geraghty K, Keane K, Davis N. Systematic review on urinary continence rates after robot-assisted laparoscopic radical prostatectomy. Ir J Med Sci. 2024.
https://doi.org/10.1007/s11845-023-03603-3 DOI: https://doi.org/10.1007/s11845-023-03603-3
Kennady EH, Zillioux J, Ali M, et al. Longitudinal urgency outcomes following robotic-assisted laparoscopic prostatectomy. World J Urol. 2023;41(7):1885–1889.
https://doi.org/10.1007/s00345-023-04458-0 DOI: https://doi.org/10.1007/s00345-023-04458-0
Aydemir H, Albayrak S, Canguven O, et al. Anorectal functions after perineal and ret-ropubic radical prostatectomy – a prospective clinical and anal mano-metric assessment. Arch Med Sci. 2011;7(1):138–142.
https://doi.org/10.5114/aoms.2011.20619 DOI: https://doi.org/10.5114/aoms.2011.20619
Walter S, Hjortswang H, Holmgren K, et al. Association between bowel symptoms, symp-tom severity, and quality of life in Swedish patients with fecal inconti-nence. Scand J Gastroenterol. 2011;46(1):6–12.
https://doi.org/10.3109/00365521.2010.513059 DOI: https://doi.org/10.3109/00365521.2010.513059
Mack I, Hahn H, Gödel C, Enck P, Bharucha AE. Global prevalence of fecal incontinence in community-dwelling adults: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023. DOI: https://doi.org/10.1016/j.cgh.2023.09.004
Townsend DC, Carrington EV, Grossi U, et al. Pathophysiology of fecal incontinence differs between men and women: a case-matched study in 200 patients. Neurogastroenterol Motil. 2016;28(10):1580–1588.
https://doi.org/10.1111/nmo.12858 DOI: https://doi.org/10.1111/nmo.12858
Hallböök O, Påhlman L, Krog M, et al. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg. 1996;224(1):58–65.
https://doi.org/10.1097/00000658-199607000-00009 DOI: https://doi.org/10.1097/00000658-199607000-00009
Sjodahl J, Walter SA, Johansson E, et al. Combination therapy with biofeedback, loperamide, and stool-bulking agents is effective for the treatment of fe-cal incontinence in women – a randomized controlled trial. Scand J Gastroenterol. 2015;50(8):965–974.
https://doi.org/10.3109/00365521.2014.999252 DOI: https://doi.org/10.3109/00365521.2014.999252
Hallböök OJ, Sjödahl RI. Compliance and manovolumetry. In: Wexner SD, Duthie GS, edi-tors. Constipation. London: Springer; 2006. p. 99–103. DOI: https://doi.org/10.1007/978-1-84628-275-1_10
Karlbom U, Lundin E, Graf W, et al. Anorectal physiology in relation to clinical subgroups of patients with severe constipation. Colorectal Dis. 2004;6(5):343–349.
https://doi.org/10.1111/j.1463-1318.2004.00632.x DOI: https://doi.org/10.1111/j.1463-1318.2004.00632.x
Nishikawa R, Honda M, Teraoka S, et al. Effects of nerve-sparing procedures on bowel function after robot-assisted radical prostatectomy: a longitudinal study. Int J Med Robot. 2020;16(6):1–10.
https://doi.org/10.1002/rcs.2156 DOI: https://doi.org/10.1002/rcs.2156
Corsini C, Bergengren O, Carlsson S, et al. Patient-reported side effects 1 year after radi-cal prostatectomy or radiotherapy for prostate cancer: a register-based nationwide study. Eur Urol Oncol. 2024 Jan 16.
https://doi.org/10.1016/j.euo.2023.12.007 DOI: https://doi.org/10.1016/j.euo.2023.12.007
Wang Z, Ni Y, Chen J, et al. The efficacy and safety of radical prostatectomy and radiother-apy in high-risk prostate cancer: a systematic review and meta-analysis. World J Surg Oncol. 2020;18(1):42.
https://doi.org/10.1186/s12957-020-01824-9 DOI: https://doi.org/10.1186/s12957-020-01824-9
Ragnarsson G, Bodemar G. Pain is temporally related to eating but not to defaecation in the irritable bowel syndrome (IBS). Patients’ description of diarrhea, constipation and symptom variation during a prospective 6-week study. Eur J Gastroenterol Hepatol. 1998;10(5):415–421. DOI: https://doi.org/10.1097/00042737-199805000-00011
https://doi.org/10.1097/00042737-
-00011
Ragnarsson G, Bodemar G. Division of the irritable bowel syndrome into subgroups on the basis of daily recorded symptoms in two outpatients samples. Scand J Gastroenterol. 1999;34(10):993–1000.
https://doi.org/10.1080/003655299750025093 DOI: https://doi.org/10.1080/003655299750025093
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Theodoros Psarias, Susanna Walter, Martin Holmbom, Issa Khayoun Issa, Firas Abdul-Sattar Aljabery, Olof Hallböök
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
