# Minor impact of anastomotic leakage in anterior resection for rectal cancer on long-term male urinary and sexual function

## TL;DR

This study found that anastomotic leakage after rectal cancer surgery has a minor negative impact on long-term urinary and sexual function in men.

## Contribution

The study is the first to evaluate the long-term urinary and sexual effects of anastomotic leakage in male rectal cancer patients.

## Key findings

- Anastomotic leakage was associated with increased urinary incontinence but not with significant sexual dysfunction.
- Higher risks of urinary frequency and sexual inactivity were observed but did not reach statistical significance.
- The impact of anastomotic leakage on urinary and sexual function was found to be minor in the long term.

## Abstract

Anastomotic leakage after anterior resection for rectal cancer induces bowel dysfunction, but the influence on urinary and sexual function is largely unknown. This cross-sectional cohort study evaluated long-term effect of anastomotic leakage on urinary and sexual function in male patients.

Patients operated with anterior resection for rectal cancer in 15 Swedish hospitals 2007–2013 were identified. Anastomotic leakage and other clinical variables were retrieved from the Swedish Colorectal Cancer Registry and medical records. Urinary and sexual dysfunction were evaluated at 4 to 11 years after surgery using the International Prostate Symptom Score, International Index of Erectile Function, and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire CR29. The effect of anastomotic leakage on average scores of urinary and sexual dysfunction was evaluated as a primary outcome, and the single items permanent urinary catheter and sexual inactivity as secondary outcomes. The association of anastomotic leakage and functional outcomes was analyzed using regression models with adjustment for confounders.

After a median follow-up of 84 months (interquartile range: 67–110), 379 out of 864 eligible men were included. Fifty-nine (16%) patients had anastomotic leakage. Urinary incontinence was more common in the leakage group, with an adjusted mean score difference measured by EORTC QLQ ColoRectal–29 of 8.69 (95% confidence interval: 0.72–16.67). The higher risks of urinary frequency, permanent urinary catheter, and sexual inactivity did not reach significance.

Anastomotic leakage after anterior resection had a minor negative impact on urinary and sexual function in men.

The online version contains supplementary material available at 10.1007/s00384-024-04626-7.