Protective effect of pelvic autonomic nerve monitoring on urinary function in male patients undergoing laparoscope-assisted radical resection for middle and low rectal cancer

Background Due to the deep location of middle and low rectal cancer, intraoperative pelvic autonomic nerve injury is likely to occur, resulting in postoperative urination dysfunction in patients. Therefore, it is very important to find ways to reduce intraoperative autonomic nerve injury.

Objective To investigate the protective effect of intraoperative monitoring of pelvic autonomic nerves (IMPAN) on urination function in male patients and its application value in reducing the incidence of intraoperative pelvic autonomic nerve injury.

Methods Clinical data about male patients who underwent laparoscopic-assisted radical resection of mid-low rectal cancer at the First Medical Center of Chinese PLA General Hospital from May 2017 to May 2019 were retrospectively analyzed. The patients were divided into surveillance group and control group according to whether they underwent IMPAN or not. A total of 81 patients were enrolled, including 41 cases in the monitoring group (31 in the bilateral successful monitoring group and 10 in the unilateral successful monitoring group) and 40 cases in the control group. The changes of urination function before and after surgery were compared by comparing the perioperative data and urination function related factors of the three groups.

Results There were no significant differences in age, tumor category, lymphatic metastasis, diameter of tumor, degree of differentiation, distance from tumor to anus, operation time, intraoperative blood loss and types of operation among the three groups (P＞0.05). The time of indwelling catheter in bilateral monitoring group and unilateral monitoring group were shorter than that in control group (59.81 ± 34.67 h, 84.50 ± 25.43 h vs 115.73 ± 50.53 h, P＜0.05). The International prostate symptom score (IPSS) of the bilateral monitoring group and the unilateral monitoring group was better than that of the control group at 1 month and 1 year after surgery (5.0 2.0 - 8.0, 4.0 1.3 - 6.8 vs 6.0 1.0 - 11.0, P<0.05; 3.0 1.0 - 5.0, 3 0.5 - 5.5 vs 4.5 0.5 - 8.5, P<0.05). The quality of life scores (QoL) of the bilateral monitoring group and the unilateral monitoring group at 1 month and 1 year after surgery were better than those of the control group (3.0 2.0 - 4.0, 2.5 1.3 - 3.8 vs 3.0 2.0 - 4.0, P<0.05; 2.0 1.0 - 3.0, 2 0.8 - 3.3 vs 3.0 2.0 - 4.0, P<0.05). In addition, there was no significant difference in the IPSS score and QoL score before and 1 year after operation in the monitoring group (P>0.05), while there was significant difference in the IPSS score and QoL score before and 1 year after operation in the control group (P<0.05).

Conclusion The application of IMPAN in laparoscopic-assisted radical resection of mid-low rectal cancer can protect the urination function of male patients, reduce the risk of intraoperative pelvic autonomic nerve injury, and improve the quality of life of patients.