The effects on pelvic visceral function of anal sphincter ablating and anal sphincter preserving operations for cancer of the lower part of the rectum and for benign colo-rectal disease

Abstract

The effects on pelvic visceral function of radical operations for carcinoma of the lower part of the rectum and of operations for inflammatory bowel disease have been determined by studying bladder, sexual and rectal function. Denervation of the bladder was diagnosed in 15% of patients who had undergone sphincter-saving resection of the rectum for carcinoma and in 19% of patients who had undergone abdominoperineal excision of the rectum. In the remaining patients, temporary, less severe, degrees of impairment of bladder function were noted. Abnormalities of function were found on urodynamic testing of patients with denervation of the bladder which explained, in part, the propensity of such patients to develop incontinence of urine. Partial recovery of function was noted in the long term in patients with denervation of the bladder and evidence consistent with regeneration of autonomic nerves was obtained on histological examination of biopsies from the bladders of such patients. In patients who had undergone conventional proctectomy for inflammatory bowel disease, impairment of bladder and sexual function was observed. In contrast, no evidence of damage to pelvic autonomic nerves was found in patients who underwent selective mucosal proctectomy. Mucosal proctectomy and ileo-anal anastomosis in patients with ulcerative colitis did impair ano-rectal reflex function; nevertheless, most patients were continent. Patients in whom, in addition to mucosal proctectomy and ileo-anal anastomosis, a pelvic ileal reservoir had been constructed had better rectal function than patients who lacked such a reservoir.