Avoidance of Permanent Sexual and Urinary Disturbances

Good surgical technique is necessary to avoid nerve damage leading to sexual dysfunction or urinary incontinence problems. The critical steps are at the pelvic rim, where the dissection is between the hypogastric nerves to the lateral and mesorectum and by dissection far down in the pelvis. When identifying the Denonvilliers' fascia, the surgeon must be aware that just lateral of it near the back side of prostate, the nerve bundles responsible for adequate bladder and sexual function may easily be injured. In rectal carcinomas, which are situated very deep and on the anterior wall, damage to this nerve structure can rarely be avoided. Routine use of the nerve stimulator Cavermap® as a guidance tool has been recently proposed [26]. Extended lymphadenectomy as described by Koyama et al. in 1984 leads to a better survival rate (18% overall, 36% in Dukes C), with the price of urinary dysfunction in 39 vs. 9% and impo-tency 76 vs. 28% [27]. Therefore, today we cannot recommend this approach.

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