Sexual and urologic problems are common both in men and women after rectal cancer surgery, although they are more common in men. They are due to damage of pelvic autonomic nerves and pelvic floor sustained during rectal dissection . The introduction of the TME technique with nerve-sparring technique has reduced the incidence of urological and sexual dysfunction .
Regarding the sexual sphere, in these patients it is very important (but sometimes it can be difficult) to distinguish problems due to anatomic damage from other symptoms linked to psychological disturbances because of depression, alteration of body perception and distress from the presence of a stoma. This evaluation permits us to help and improve the life of these patients with appropriate support. There are contradictory reports in the literature but it seems that patients' lives are likely to be beset by a poorly functional stoma or by a bad coping strategy more than the stoma per se.
The incidence of erectile and ejaculation dysfunction after surgery is reported to be very high after APE, ranging from 18 to 92% [40, 51, 61], while it is lower after AR (ranging from 9 to 30%) [45, 62, 63]. Loss of desire, diminished sexual activity and anor-gasmia are also reported.
The prevalence of sexual problems in men seems to be higher in the elderly, but there is still debate about this, as it seems that, over time, older patients (>70 years old) recover continuously, while younger patient still complain of problems after 2 years .
Sexual problems in females are less investigated but cessation of intercourse, anorgasmia and dys-pareunia are the most common problems . The incidence of sexual dysfunction is higher after APE also in women.
The major urologic problems are incontinence, retention and dysuria. These are more commonly associated with APE than AR . Supraradical lym-phadenectomy affects urinary function in more than 30% of patients and in 20% of patients long-term use of a urinary catheter is needed .
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