Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1988 Oct;208(4):391–400. doi: 10.1097/00000658-198810000-00001

Radical pelvic surgery with preservation of sexual function.

P C Walsh 1, P N Schlegel 1
PMCID: PMC1493736  PMID: 3178328

Abstract

Recent neuroanatomical findings make it possible to identify the pelvic plexus and branches that innervate the corpora cavernosa intraoperatively. These anatomical principles have been used to modify standard radical prostatectomy and cystoprostatectomy to prevent postoperative sexual dysfunction. Radical retropubic prostatectomy has been performed on 320 men, who have been followed for 1-5 years after surgery; 74% of these men are now potent after surgery. Positive surgical margins were present in 10% of the cases; the actuarial overall local recurrence at 5 years (with or without distant metastases) is 10%. These results are consistent with past experience and data reported elsewhere in the literature. Radical cystoprostatectomy has been performed on 25 men over the past 5 years. Pathologic evaluation of all specimens demonstrated negative surgical margins, no patient has developed local recurrence, and of the patients who had cystectomy alone, 83% are now potent after surgery. With application of these principles to colorectal surgery, similar favorable impact on quality of life with improved surgical accuracy may be possible.

Full text

PDF
393

Images in this article

392Fig. 1.
on p.392

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BACON H. E., BRALOW S. P., BERKLEY J. L. Rehabilitation and long-term survival after colectomy for ulcerative colitis. J Am Med Assoc. 1960 Jan 23;172:324–328. doi: 10.1001/jama.1960.03020040022007. [DOI] [PubMed] [Google Scholar]
  2. Balslev I., Harling H. Sexual dysfunction following operation for carcinoma of the rectum. Dis Colon Rectum. 1983 Dec;26(12):785–788. doi: 10.1007/BF02554748. [DOI] [PubMed] [Google Scholar]
  3. Bauer J. J., Gelernt I. M., Salk B. A., Kreel I. Proctectomy for inflammatory bowel disease. Am J Surg. 1986 Jan;151(1):157–162. doi: 10.1016/0002-9610(86)90026-7. [DOI] [PubMed] [Google Scholar]
  4. Bauer J. J., Gelernt I. M., Salky B., Kreel I. Sexual dysfunction following proctocolectomy for benign disease of the colon and rectum. Ann Surg. 1983 Mar;197(3):363–367. doi: 10.1097/00000658-198303000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bernstein W. C., Bernstein E. F. Sexual dysfunction following radical surgery for cancer of the rectum. Dis Colon Rectum. 1966 Sep-Oct;9(5):328–332. doi: 10.1007/BF02617099. [DOI] [PubMed] [Google Scholar]
  6. Berry A. R., de Campos R., Lee E. C. Perineal and pelvic morbidity following perimuscular excision of the rectum for inflammatory bowel disease. Br J Surg. 1986 Aug;73(8):675–677. doi: 10.1002/bjs.1800730831. [DOI] [PubMed] [Google Scholar]
  7. Burnham W. R., Lennard-Jones J. E., Brooke B. N. Sexual problems among married ileostomists. Survey conducted by The Ileostomy Association of Great Britain and Ireland. Gut. 1977 Aug;18(8):673–677. doi: 10.1136/gut.18.8.673. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. COLEMAN S. T., ECKERT C. Preservation of rectum in familial polyposis of the colon and rectum. AMA Arch Surg. 1956 Oct;73(4):635–644. doi: 10.1001/archsurg.1956.01280040091011. [DOI] [PubMed] [Google Scholar]
  9. Catalona W. J., Dresner S. M. Nerve-sparing radical prostatectomy: extraprostatic tumor extension and preservation of erectile function. J Urol. 1985 Dec;134(6):1149–1151. doi: 10.1016/s0022-5347(17)47662-2. [DOI] [PubMed] [Google Scholar]
  10. Corman M. L., Veidenheimer M. C., Coller J. A. Impotence after proctectomy for inflammatory disease of the bowel. Dis Colon Rectum. 1978 Sep;21(6):418–419. doi: 10.1007/BF02586718. [DOI] [PubMed] [Google Scholar]
  11. DONOVAN M. J., O'HARA E. T. Sexual function following surgery for ulcerative colitis. N Engl J Med. 1960 Apr 7;262:719–720. doi: 10.1056/NEJM196004072621407. [DOI] [PubMed] [Google Scholar]
  12. Danzi M., Ferulano G. P., Abate S., Califano G. Male sexual function after abdominoperineal resection for rectal cancer. Dis Colon Rectum. 1983 Oct;26(10):665–668. doi: 10.1007/BF02553339. [DOI] [PubMed] [Google Scholar]
  13. Davis L. P., Jelenko C. Sexual function after abdominoperineal resection. South Med J. 1975 Apr;68(4):422–426. doi: 10.1097/00007611-197504000-00010. [DOI] [PubMed] [Google Scholar]
  14. Devlin H. B., Plant J. A., Griffin M. Aftermath of surgery for anorectal cancer. Br Med J. 1971 Aug 14;3(5771):413–418. doi: 10.1136/bmj.3.5771.413. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Eggleston J. C., Walsh P. C. Radical prostatectomy with preservation of sexual function: pathological findings in the first 100 cases. J Urol. 1985 Dec;134(6):1146–1148. doi: 10.1016/s0022-5347(17)47661-0. [DOI] [PubMed] [Google Scholar]
  16. Fazio V. W., Fletcher J., Montague D. Prospective study of the effect of resection of the rectum on male sexual function. World J Surg. 1980;4(2):149–152. doi: 10.1007/BF02393562. [DOI] [PubMed] [Google Scholar]
  17. Fegiz G., Trenti A., Bezzi M., Ambrogi V., Papini Papi M., Tucci G., Angelini L. Sexual and bladder dysfunctions following surgery for rectal carcinoma. Ital J Surg Sci. 1986;16(2):103–109. [PubMed] [Google Scholar]
  18. Grüner O. P., Naas R., Fretheim B., Gjone E. Marital status and sexual adjustment after colectomy. Results in 178 patients operated on for ulcerative colitis. Scand J Gastroenterol. 1977;12(2):193–197. doi: 10.1203/00006450-199404000-00018. [DOI] [PubMed] [Google Scholar]
  19. Hjortrup A., Kirkegaard P., Friis J., Sanders S., Andersen F. Sexual dysfunction after low anterior resection for midrectal cancer. Acta Chir Scand. 1984;150(8):687–688. [PubMed] [Google Scholar]
  20. Kinn A. C., Ohman U. Bladder and sexual function after surgery for rectal cancer. Dis Colon Rectum. 1986 Jan;29(1):43–48. doi: 10.1007/BF02555287. [DOI] [PubMed] [Google Scholar]
  21. Leicester R. J., Ritchie J. K., Wadsworth J., Thomson J. P., Hawley P. R. Sexual function and perineal wound healing after intersphincteric excision of the rectum for inflammatory bowel disease. Dis Colon Rectum. 1984 Apr;27(4):244–248. doi: 10.1007/BF02553795. [DOI] [PubMed] [Google Scholar]
  22. Lepor H., Gregerman M., Crosby R., Mostofi F. K., Walsh P. C. Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatomical study of the adult male pelvis. J Urol. 1985 Feb;133(2):207–212. doi: 10.1016/s0022-5347(17)48885-9. [DOI] [PubMed] [Google Scholar]
  23. Lue T. F., Zeineh S. J., Schmidt R. A., Tanagho E. A. Neuroanatomy of penile erection: its relevance to iatrogenic impotence. J Urol. 1984 Feb;131(2):273–280. doi: 10.1016/s0022-5347(17)50344-4. [DOI] [PubMed] [Google Scholar]
  24. May R. E. Sexual dysfunction following rectal excision for ulcerative colitis. Br J Surg. 1966 Jan;53(1):29–30. doi: 10.1002/bjs.1800530106. [DOI] [PubMed] [Google Scholar]
  25. McDonald P. J., Heald R. J. A survey of postoperative function after rectal anastomosis with circular stapling devices. Br J Surg. 1983 Dec;70(12):727–729. doi: 10.1002/bjs.1800701211. [DOI] [PubMed] [Google Scholar]
  26. Neal D. E. 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. Ann R Coll Surg Engl. 1984 Jan;66(1):7–13. [PMC free article] [PubMed] [Google Scholar]
  27. Reiner W. G., Walsh P. C. An anatomical approach to the surgical management of the dorsal vein and Santorini's plexus during radical retropubic surgery. J Urol. 1979 Feb;121(2):198–200. doi: 10.1016/s0022-5347(17)56718-x. [DOI] [PubMed] [Google Scholar]
  28. STAHLGREN L. H., FERGUSON L. K. Influence on sexual function of abdominoperineal resection for ulcerative colitis. N Engl J Med. 1958 Oct 30;259(18):873–875. doi: 10.1056/NEJM195810302591806. [DOI] [PubMed] [Google Scholar]
  29. Santangelo M. L., Romano G., Sassaroli C. Sexual function after resection for rectal cancer. Am J Surg. 1987 Nov;154(5):502–504. doi: 10.1016/0002-9610(87)90264-9. [DOI] [PubMed] [Google Scholar]
  30. Schellhammer P. F. Radical prostatectomy. Patterns of local failure and survival in 67 patients. Urology. 1988 Mar;31(3):191–197. doi: 10.1016/0090-4295(88)90137-9. [DOI] [PubMed] [Google Scholar]
  31. Schlegel P. N., Walsh P. C. Neuroanatomical approach to radical cystoprostatectomy with preservation of sexual function. J Urol. 1987 Dec;138(6):1402–1406. doi: 10.1016/s0022-5347(17)43655-x. [DOI] [PubMed] [Google Scholar]
  32. Smith P. H., Ballantyne B. The neuroanatomical basis for denervation of the urinary bladder following major pelvic surgery. Br J Surg. 1968 Dec;55(12):929–933. doi: 10.1002/bjs.1800551212. [DOI] [PubMed] [Google Scholar]
  33. VAN PROHASKA J., SIDERIUS N. J. The surgical rehabilitation of patients with chronic ulcerative colitis. Am J Surg. 1962 Jan;103:42–46. doi: 10.1016/0002-9610(62)90010-7. [DOI] [PubMed] [Google Scholar]
  34. WAUGH J. M., MILLER E. M., KURZWEG F. T. Abdominoperineal resection with sphincter preservation for carcinoma of the midrectum. AMA Arch Surg. 1954 Apr;68(4):468–485. [PubMed] [Google Scholar]
  35. Walsh P. C., Donker P. J. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982 Sep;128(3):492–497. doi: 10.1016/s0022-5347(17)53012-8. [DOI] [PubMed] [Google Scholar]
  36. Walsh P. C., Epstein J. I., Lowe F. C. Potency following radical prostatectomy with wide unilateral excision of the neurovascular bundle. J Urol. 1987 Oct;138(4):823–827. doi: 10.1016/s0022-5347(17)43385-4. [DOI] [PubMed] [Google Scholar]
  37. Walsh P. C., Mostwin J. L. Radical prostatectomy and cystoprostatectomy with preservation of potency. Results using a new nerve-sparing technique. Br J Urol. 1984 Dec;56(6):694–697. doi: 10.1111/j.1464-410x.1984.tb06149.x. [DOI] [PubMed] [Google Scholar]
  38. Walsh P. C. Radical prostatectomy, preservation of sexual function, cancer control. The controversy. Urol Clin North Am. 1987 Nov;14(4):663–673. [PubMed] [Google Scholar]
  39. Watts J. M., de Dombal F. T., Goligher J. C. Long-term complications and prognosis following major surgery for ulcerative colitis. Br J Surg. 1966 Dec;53(12):1014–1023. doi: 10.1002/bjs.1800531203. [DOI] [PubMed] [Google Scholar]
  40. Weinstein M., Roberts M. Sexual potency following surgery for rectal carcinoma. A followup of 44 patients. Ann Surg. 1977 Mar;185(3):295–300. doi: 10.1097/00000658-197703000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Williams J. T., Slack W. W. A prospective study of sexual function after major colorectal surgery. Br J Surg. 1980 Nov;67(11):772–774. doi: 10.1002/bjs.1800671103. [DOI] [PubMed] [Google Scholar]
  42. Williams N. S., Johnston D. The quality of life after rectal excision for low rectal cancer. Br J Surg. 1983 Aug;70(8):460–462. doi: 10.1002/bjs.1800700805. [DOI] [PubMed] [Google Scholar]
  43. Yeager E. S., Van Heerden J. A. Sexual dysfunction following proctocolectomy and abdominoperineal resection. Ann Surg. 1980 Feb;191(2):169–170. doi: 10.1097/00000658-198002000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. de Bernardinis G., Tuscano D., Negro P., Flati G., Flati D., Bianchini A., Carboni M. Sexual dysfunction in males following extensive colorectal surgery. Int Surg. 1981 Apr-Jun;66(2):133–135. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES