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Anorectal dysfunction after radical cystectomy for bladder cancer

Liedberg, Fredrik LU ; Hagberg, Oskar LU ; Baseckas, Gediminas ; Brändstedt, Johan LU ; Kollberg, Petter LU ; Lind, Anna-Karin ; Lydrup, Marie Louise LU ; Löfgren, Annica LU ; Stenzelius, Karin LU and Sörenby, Anne LU , et al. (2022) In Scandinavian Journal of Urology 56(2). p.155-161
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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bladder cancer, cystectomy, LARS-score, manovolumetry, St Mark’s score, ultrasound
in
Scandinavian Journal of Urology
volume
56
issue
2
pages
155 - 161
publisher
Taylor & Francis
external identifiers
  • scopus:85122793726
  • pmid:35019814
ISSN
2168-1805
DOI
10.1080/21681805.2021.2025423
language
English
LU publication?
yes
id
0be5144f-a6d1-4036-875f-0f3d00084d6d
date added to LUP
2022-02-21 15:45:13
date last changed
2022-07-28 07:07:55
@article{0be5144f-a6d1-4036-875f-0f3d00084d6d,
  abstract     = {{<p>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.</p>}},
  author       = {{Liedberg, Fredrik and Hagberg, Oskar and Baseckas, Gediminas and Brändstedt, Johan and Kollberg, Petter and Lind, Anna-Karin and Lydrup, Marie Louise and Löfgren, Annica and Stenzelius, Karin and Sörenby, Anne and Starck, Marianne}},
  issn         = {{2168-1805}},
  keywords     = {{Bladder cancer; cystectomy; LARS-score; manovolumetry; St Mark’s score; ultrasound}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{155--161}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Urology}},
  title        = {{Anorectal dysfunction after radical cystectomy for bladder cancer}},
  url          = {{http://dx.doi.org/10.1080/21681805.2021.2025423}},
  doi          = {{10.1080/21681805.2021.2025423}},
  volume       = {{56}},
  year         = {{2022}},
}