The Effects on Urination and Defecation of Preservation of the Autonomic Nervous Systme in Surgery for Rectal Cancer

Abstract

The sympathetic and parasympathetic nervous systems were preserved using a CUSA (Cavitron Ultrasonic Surgical Aspirator) during radical resection of rectal cancer in 18 patients. The effects of preservation of the autonomic nervous system on urination and defecation were studied in these patients, and the results were compared with those from groups of patients who had undergone low anterior resection (LAR) (18 cases; control-I) and abdominoperineal resection (APR) (16 cases; control-II) without preservation of the autonomic nervous system. Desire to urinate appeared in 1-5 days (median 2 days) after surgery in the CUSA-treated group, and in 2-32+ days (14+ days) and 1-41+ days (25+ days) in the LAR and APR groups, respectively. Urethral catheters were removed 2-10 days (6 days) after surgery in the CUSA group, and 4-61 days (12 days) in the LAR and 6-67 days (22 days) in the APR group, after surgery respectively. In the APR group, three patients retained urethral catheters for longer than 1, 000 days after surgery. No difference in defecation was observed between the CUSA-treated group and the two control groups. Preservation of the autonomic nervous system in receal surgery was thus considered extremely important and further developments in surgical techniques and instruments should be performed.