Anorectal dysfunction after radical cystectomy for bladder cancer

Abstract

Objective: To prospectively assess anorectal dysfunction using patient-reported outcomes using validated questionnaires, manovolumetry and endoanal ultrasound before and 12 months after RC.

Patients and methods: From 2014 to 2019, we prospectively included 44 patients scheduled for RC. Preoperatively and 12 months after surgery, 41 patients filled in a low anterior resection syndrome score (LARS-score) to assess fecal incontinence, increased frequency, urgency and emptying difficulties and a St Mark’s score to assess fecal incontinence in conjunction with manovolumetry and endoanal ultrasound examinations. Pre- and postoperative patient-reported anorectal dysfunction were assessed by LARS-score and St Marks’s score. At the same time-points, anorectal function was evaluated by measuring mean anal resting and maximal squeeze pressures, volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry. Wilcoxon's signed rank test was used to compare pre- and postoperative outcomes by questionnaires.

Results: Postoperatively 6/41 (15%) patients reported flatus incontinence assessed by the LARS-questionnaire, and correspondingly the St Mark’s score increased postoperatively. The median anal resting pressure decreased from 57 mmHg preoperatively to 46 mmHg after RC, but without any postoperative anatomic defects detected by endoanal ultrasound. Volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry all increased after RC, indicating decreased postoperative rectal sensation, as rectal compliance was unaltered.

Conclusions: Postoperative flatus incontinence is reported by one out of seven patients after RC, which corresponds to decreased anal resting pressures. The finding of decreased rectal sensation might also contribute to patient-reported symptoms and anorectal dysfunction after RC.

Keywords:

• Bladder cancer
• cystectomy
• LARS-score
• St Mark’s score
• manovolumetry
• ultrasound

Disclosure statement

None of the authors have any conflicts of interest.

Additional information

Funding

This work was supported by the Swedish Cancer Society [CAN 2017/278 and CAN 2020/709], Lund Medical Faculty (ALF), Skåne University Hospital Research Funds, the Gyllenstierna Krapperup’s Foundation, Skåne County Council’s Research and Development Foundation [REGSKANE-821461], the Cancer Research Fund at Malmö General Hospital, Gösta Jönsson Research Foundation, the Foundation of Urological Research (Ove and Carin Carlsson Bladder Cancer donation), and Hillevi Fries Research Foundation. The funding sources had no role in the study design, data analyses, interpretation of the results, or writing the manuscript.