Half of patients experience moderate to severe long-term urination dysfunction after rectal cancer surgery: a prospective cohort study

Urination dysfunction is a known late sequela after rectal cancer surgery. Although it negatively affects the quality of life for these patients, evidence of rate is missing. The aim was to report the rate of late urination dysfunction in patients undergoing mesorectal excision, transanal microsurgery, or abdominoperineal excision for rectal cancer. This was a prospective cohort study conducted at Herlev Hospital, Denmark. Patients with primary or recurrent rectal cancer who underwent rectal cancer operations between September 2019 and May 2023 were invited to answer an electronic questionnaire 3–12 months postoperatively. The primary outcome included urination dysfunction, incontinence, retention, and increased urinary frequency, divided by operative method. Subgroup analyses compared patient characteristics, cancer location, and operative features. This study included 121 mostly male patients in their sixties, with the most common procedure being robot-assisted surgery. Overall, 49% experienced urination dysfunction, more frequently in males (p=0.02), patients undergoing oncologic therapy (p=0.04), and those who had open surgery compared to robot-assisted or laparoscopic procedures (p=0.01). The dysfunction was most common in patients with midrectal tumors, and symptoms did not improve over time. The extent of the tissue resection varies depending on the surgical procedures, introducing variability in the details of the pathological report. Further, there is a risk of recall bias for preoperative symptoms. Half of the rectal cancer surgery patients at our center experienced moderate to severe urinary dysfunction, particularly men and those who had oncologic therapy or open surgery. • Prospective cohort of 121 rectal cancer surgery patients assessed urinary dysfunction • Nearly half (49%) experienced late urinary dysfunction postoperatively • Male sex, prior oncologic therapy, and open surgery were significant risk factors • Midrectal tumors were most frequently associated with urinary symptoms • Symptoms showed no improvement over time, impacting long-term quality of life