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

Background 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. Methods 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. Results 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. Conclusion 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.