Impotence after mesorectal and close rectal dissection for inflammatory bowel disease

PURPOSE: Close rectal dissection is a surgical technique used by some surge ons in inflammatory bowel disease. It is performed within the mesorectum, c lose to the rectal muscle wall, with the aim of minimizing damage to the pe lvic sexual nerves. Other surgeons dissect in the more anatomical mesorecta l plane. Our aim was to determine whether close rectal dissection is more p rotective of the pelvic sexual nerves than mesorectal dissection. METHOD: P atients undergoing surgery for inflammatory bowel disease were entered pros pectively into a database. Male patients were mailed a standardized, valida ted, urologic impotence questionnaire: the International Index of Erectile Function. RESULTS: There was an 81 percent response rate. Six of 156 assess able patients were totally impotent (3.8 percent). They were all in the 50- year-old to 70-year-old age group, with no impotence in patients younger th an 50 years old. Twenty-one patients complained of minor diminution of erec tile function (13.5 percent), where sexual activity was still possible. The re was no statistical difference in the rate of complete (2.2 percent vs. 4 .5 percent, P = 0.67) or partial (13.5 percent vs. 13.3 percent, P = 0.99) impotence between close rectal and mesorectal dissection (Fisher's exact te st). There were no ejaculatory difficulties. The time elapsed since surgery ranged from 2.7 months to 192.7 months, with a median of 74.5 months. CONC LUSION: Rectal excision for inflammatory bowel disease can be conducted wit h low rates of impotence. Minor degrees of erectile dysfunction may be more common than currently recognized. We could not demonstrate that close rect al dissection significantly protects the patient from impotence compared wi th operating in the anatomical mesorectal plane. Age appears to be the most important risk factor for postoperative impotence.