Incidence of The Bowel, Bladder, and Sexual Dysfunction Following Surgery for Colorectal Malignancy
Condition: Bowel Dysfunction; Bladder Dysfunction; Sexual Dysfunction; Colorectal Surgery
MeSH terms: Intestinal Diseases
Study type: Observational [Patient Registry]

Summary: 
      Colorectal cancer is the second most common cancer by the site in Europe and the third most
      common cancer in the USA with high morbidity and mortality. Survival after the treatment has
      improved over the past few decades as a result of early diagnosis, radiotherapy, and advances
      in surgical techniques such as abdominoperineal resection (APR), low anterior resection (LAR)
      and total mesorectal excision (TME). These innovative surgeries are the current standard
      treatment for the mid and the low rectal cancers which avoids the permanent colostomy. It is
      very difficult to find out the incidence of the bowel, bladder and sexual dysfunction of
      patients either because they are embarrassed or because they do not relate their symptoms to
      rectal cancer treatment. This article reports the incidence of the bowel, bladder and sexual
      dysfunction following surgery for rectal cancer from the National Academy of Medical
      Sciences, Bir Hospital, a tertiary level hospital.
    

Detailed description: 
      It was a cross-sectional study at Bir Hospital and the duration of the study was from
      December 2014 to December 2017. Here, all the patients who underwent LAR and APR following
      neoadjuvant chemoradiotherapy were included. And, all the patients with recurrence after
      surgery, lost to follow up, benign disease, who did not undergo neoadjuvant
      chemoradiotherapy, and who underwent trans-anal excision were excluded from the study. In our
      study, the independent variable will be the type of surgery done for colorectal malignant
      disease. And the dependent variables will be the postoperative complications in the form of
      immediate and delayed complications. Immediate could be infectious or non-infectious
      complications and delayed (long term) complications could be bowel, bladder, and sexual
      dysfunction respectively.

      Data collection was done using structured Performa that included all the demographic
      parameters, examination findings which included the data regarding neoadjuvant
      chemoradiotherapy and type of surgery (LAR and APR) were included. The laboratory parameters
      were also included. All the operative and post-operative details were included regarding
      bowel, bladder, and sexual dysfunction. And validated tools were used to calculate and
      analyze data.

      LARS Score Questionnaire: The aim of this questionnaire was to assess the bowel function
      using a validated questionnaire.6 The LARS consists of five questions and can be used to
      generate an overall score that translates into no LARS (score 0-20), minor LARS (21-29), and
      major LARS (30-42) respectively.

      IPSS Questionnaire: Assessment of bladder dysfunction was assessed by the validated
      questionnaire of International Prostatic Symptoms Score (IPSS) for bladder dysfunction.8 For
      the evaluation of preoperative and postoperative bladder function, a urologic history and
      residual urine volume measurements by ultrasound were done.

      Sexual Function Evaluation: In the early period after surgery sexual function was measured
      using the validated questionnaire - the International Index of Female Sexual Function (IFSF)
      for females and the International Index of Erectile Function (IIEF) for males. These tools
      helped to assess the impact of a specific treatment modality by evaluating different sexual
      function domains. Our study group was small, so we did not classify the groups into mild,
      moderate, and severe dysfunction groups. We did the overall long term assessment of the
      patients who came for the follow-up. These specific questionnaires were asked and the
      assessment was done for the overall dysfunctions.

      Ethics: The study was approved by the institutional ethical committee- "IRB of NAMS, Bir
      Hospital" and written consent was obtained from all of the patients.

      Statistics: All the data were entered in SPSS version 16 and then statistical analysis was
      done. Type of surgery, the status of neoadjuvant chemoradiotherapy, and the postoperative
      outcomes were studied respectively. Correlation and logistic regression statistic tools were
      used. A comprehensive literature search published in English was done until 2019 using
      Hinari, PubMed, and Cochrane Library.
    

Intervention name(s): Surgery for Colorectal malignant diseases either LAR or APR
Intervention type(s): Procedure
Intervention description(s): Patients following LAR or APR were observed for the Bowel, Bladder, and Sexual Dysfunction
Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        It was a cross-sectional study at Bir Hospital and the duration of the study was from
        December 2014 to December 2017. Out of 38 patients included for surgery 12 were excluded
        due to poor follow up and those patients who underwent upfront surgery. Only 26 patients
        were included in the study. There were 20 (76.9%) males and 6 (23.1%) females respectively.
        The mean age of the patient was 43.577yrs (26-75) and mean BMI was 20.78. The number of
        patients that underwent LAR was 24 (92.30%) and those who underwent APR were 2( 7.6%) after
        neoadjuvant chemoradiotherapy respectively. Immediate could be infectious or non-infectious
        complications and delayed (long term) complication could be bowel, bladder, and sexual
        dysfunction respectively.