The Frequency of Urination Dysfunction in Patients Operated on for Rectal Cancer: A Systematic Review with Meta-Analyses

Abstract

The frequency of long-term urination dysfunction after surgery for rectal cancer remains unclear, yet it is essential to establish this to improve treatment strategies. Randomized controlled trials (RCTs), non-RCTs, and cohort studies were included with patients having undergone sphincter-preserving total (TME) or partial mesorectal excision (PME) for the treatment of primary rectal cancer in this review. The outcome was urination dysfunction reported at least three months postoperatively, both overall urination dysfunction and subdivided into specific symptoms. The online databases PubMed, Embase, and Cochrane CENTRAL were searched, bias was assessed using the Newcastle-Ottawa scale, and results were synthesized using one-group frequency meta-analyses. A total of 55 studies with 15,072 adults were included. The median follow-up was 29 months (range 3-180). The pooled overall urination dysfunction was 21% (95% confidence interval (CI) 12%-30%) 3-11 months postoperatively and 25% (95% CI 19%-32%) ≥12 months postoperatively. Retention and incontinence were common 3-11 months postoperatively, with pooled frequencies of 11% and 14%, respectively. Increased urinary frequency, retention, and incontinence seemed even more common ≥12 months postoperatively, with pooled frequencies of 37%, 20%, and 23%, respectively. In conclusion, one in five patients experienced urination dysfunction more than a year following an operation for rectal cancer.

Keywords: late complications; rectal cancer; total mesorectal excision; urinary incontinence; urinary retention; urination disorders.

Figure 1

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 flow diagram of the study selection process. n: number.

Figure 2

(a) Forest plot depicting one-group meta-analysis of overall urination dysfunction 3–11 months after surgery [23,24,25,26,27,28,29,30,31,32,33,34,36,39,40,41,42,43,44,45,46]. CI: confidence interval. (b) Forest plot depicting one-group meta-analysis of overall urination dysfunction ≥12 months after surgery [8,28,29,35,36,47,48,50,51,52,53,54,55,56,58,59,60,61]. CI: confidence interval. (c) Forest plot depicting one-group meta-analysis of overall urination dysfunction ≥3 months after surgery but not further specified [61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77]. CI: confidence interval.

Figure 2

(a) Forest plot depicting one-group meta-analysis of overall urination dysfunction 3–11 months after surgery [23,24,25,26,27,28,29,30,31,32,33,34,36,39,40,41,42,43,44,45,46]. CI: confidence interval. (b) Forest plot depicting one-group meta-analysis of overall urination dysfunction ≥12 months after surgery [8,28,29,35,36,47,48,50,51,52,53,54,55,56,58,59,60,61]. CI: confidence interval. (c) Forest plot depicting one-group meta-analysis of overall urination dysfunction ≥3 months after surgery but not further specified [61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77]. CI: confidence interval.