Effects of Laparoscopic Pelvic Autonomic Nerve-Preserving Radical Resection of Rectal Cancer on Urinary and Sexual Function

Objective:To investigate and analyze the effect of laparoscopic pelvic autonomic nerve-preserving radical resection of rectal cancer on urinary and sexual function.Methods:Cases of laparoscopic radical resection of rectal cancer in our hospital from April 2018 to April 2023 were selected,and 60 patients who met the requirements were included as research subjects.The patients were divided into an experimental group and a reference group by a double-blind mechanism,with 30 cases in each group.The experimental group underwent laparoscopic pelvic autonomic radical resection,while the reference group underwent ordinary radical resection.The voiding function,urodynamics,sexual function,and blood indexes of the patients of both groups were compared.Results:The total incidence of voiding dysfunction in the experimental group was significantly lower than in the reference group(P<0.05).Urodynamics such as abdominal leak point pressure(ALPP),maximum urethral pressure(MUP),maximum urethral closure pressure(MUCP),and functional urethral length(FUL)in the experimental group were significantly better than those in the reference group(P<0.05).The incidences of erectile dysfunction and ejaculatory dysfunction in the experimental group were significantly lower than those in the reference group(P<0.05).Before the surgery,there were no significant differences in the blood indexes such as C-reactive protein(CRP),cortisol(Cor),and pre-albumin(PA)between the two groups(P>0.05);after the operation,the blood indexes of the patients in the experimental group were significantly better than those in the reference group(P<0.05).Conclusion:Laparoscopic pelvic autonomic nerve-preserving radical resection of rectal cancer has lesser effects on urinary and sexual functions.

A Feasibility Study of an Individualized Voiding Program in Japan to Improve the Sense of Control in Older People with Functional Urinary Incontinence

Purpose: This study intended to assess the feasibility of an individualized voiding program in Japan aimed at improving the sense of micturition control in older people with functional urinary incontinence. Method: Following the interview guide, FGIs were conducted in two groups (4 - 6 participants) consisting of nurses and care workers with more than 5 years of experience as practitioners of urination care. Data were analyzed using a qualitative descriptive approach. Results: We determined that the program purpose is to “enable caregivers to work as a well-coordinated team to humanely facilitate excretion independence in older people, which is essential for living with dignity”, as this confirmed the importance of maintaining the sense of micturition control in older people for their well-being. In the program outline, we extracted the following five categories: 1) setting selection criteria for recipients considering the status of micturition induction, 2) careful collection of information and assessment of lower urinary tract symptoms in older people in case of environmental changes, 3) examination of methods used for assessing lower urinary tract symptoms according to the facility environment, 4) confirmation of the recipient’s micturition habits and request for assistance, and 5) conducting necessary examination for setting the intervention period and evaluation period according to the target condition. The feedback on the program guide was summarized in the statement—specific successful cases help frame and implement the micturition induction plan. Conclusion: We confirmed the feasibility of the micturition induction plan for improving the sense of control in older people with functional urinary incontinence. Upon evaluating the program guide, we deemed that referring to specific successful cases helps frame and implement the micturition induction plan. It is extremely important to verify the effectiveness of the program going forward.

Impact of postoperative sexual function on health-related quality of life after robot-assisted radical prostatectomy

Background:We investigated potential disparities in health-related quality of life,particularly concerning urinary function,between patients with preserved and those with impaired sexual function after robot-assisted radical prostatectomy(RARP).Materials and methods:BetweenDecember 2012 and April 2020,704men underwent RARP in our hospital.This study included 155 patients with a preoperative 5-item International Index of Erectile Function(IIEF-5)of≥12 points and an assessable IIEF-5 at 12 months postoperatively.Health-related quality of life was assessed using the 8-item Short-Form Health Survey and Expanded Prostate Cancer Index Composite(EPIC)preoperatively and at 3,6,and 12months postoperatively.A logistic regression analysis andWilcoxon rank sum tests were performed.Results:Patients were grouped according to the median IIEF-5 score 12 months after surgery:those with preserved sexual function(n=71)and those with impaired sexual function(n=84).The mental component summary of the 8-item Short-Form Health Survey was better in the group with preserved sexual function at 6 months postoperatively than in the group with impaired sexual function(p<0.01).In the EPIC,the group with preserved sexual function performed better not only in the sexual domain but also in the urinary domain at all time points comparedwith the groupwith impaired sexual function(p<0.01).In the comparison of the urinary subdomains of the EPIC,there were no significant differences in urinary function or incontinence,but there were significant differences in urinary distress and irritative/obstructive scores(p<0.01).Conclusions:Patients with preserved postoperative sexual function after RARP showed better urinary function than those with impaired sexual function.Hence,preserved sexual function is closely associated with urinary function.