Voiding dysfunction after pelvic colorectal surgery

Abstract

Bladder dysfunction following colorectal surgery may be related to extirpative procedures in the region of the pelvic autonomic plexus. The most common etiology is from autonomic disruption during abdominoperineal or low anterior resections. Contemporary technical modifications have allowed surgeons to achieve oncologic control while preserving the autonomic nerves that innervate the bladder and sexual organs. Although these modifications have resulted in a significant decrease in the incidence of postoperative bladder dysfunction, bladder dysfunction continues to be a source of significant morbidity after surgery. In this patient population, symptoms are not reliable for accurate diagnosis. The use of urodynamics provides objective measurements of bladder and outlet function and are paramount in providing an accurate diagnosis and in recommending treatments. Follow-up and treatment are highly individualized based on urodynamic findings, patient expectations, patient abilities, and family support. This article provides an overview of pertinent neuroanatomy, diagnosis, urodynamic interpretation, and treatment related to bladder dysfunction following pelvic colorectal surgery.

Keywords: Voiding dysfunction; colorectal surgery; urinary retention.

Figures

Figure 1

Multichannel urodynamics. Pressure sensitive catheters placed in the rectum and bladder. Pdet=Pves-Pabd Flow rate is determined by flowmeter collection of urine passed by the urethra into a collecting device.

Figure 2

Multichannel urodynamics–detrusor overactivity. Circle: Shows involuntary bladder contraction. Arrow: Urinary leakage.

Figure 3

Multichannel urodynamics—stress urinary incontinence/intrinsic sphincter deficiency. Arrows: Urinary leakage occurrences. Circle: Increased abdominal pressure (without increased Pdet) corresponding to urinary leakage with stress urinary incontinence.

Figure 4

Multichannel urodynamics—hypocontractile bladder. Urodynamic findings after parasympathetic denervation following pelvic surgery. Arrow showing low pressure insufficient bladder contractions despite bladder volume approaching one liter (rectangle).

Figure 5

Multichannel urodynamics—outlet obstruction. Urodynamic findings showing high pressure detrusor contraction (circle) with only low urinary flow (arrow 5 mL/s) resulting from outlet obstruction (prostate, bladder neck, or urethra).

Figure 6

Multichannel urodynamics—noncompliant bladder. High pressure bladder during storage phase of micturition. Medical or surgical treatments can be applied. If left untreated, this patient could develop upper tract (renal) injury.