***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Bladder and sexual dysfunction are recognized complications of mesorectal resection . Their incidence following laparoscopic surgery is unknown Objective To assess the efficacy of a novel coloplasty colonic pouch design in optimizing bowel function after ultralow anterior resection . Summary Background Data A colonic J-pouch may reduce excessive stool frequency and incontinence after anterior resection , but at the risk of evacuation problems . Experimental surgery on pigs has suggested that a coloplasty pouch ( CP ) may be a useful alternative . Although CP has recently been shown to be feasible in patients , there is no r and omized controlled trial comparing bowel function with the J-pouch . Methods After anterior resection for cancer , patients were allocated to either  J-pouch or CP-anal anastomoses .  Continence scoring , anorectal manometry , and endoanal ultrasound assessment s were made before surgery . All complications were recorded , and these preoperative assessment s were repeated at 4 months . The assessment s were repeated again at 1 year , and a quality of life question naire was added . Results Eighty-eight patients were recruited from October 1998 to April 2000 . Both groups were well matched for age , gender , staging , adjuvant therapy , and mean follow-up . There were no differences in the intraoperative time and hospital stay . CP result ed in more anastomotic leaks . At 4 months , J-pouch patients had 10.3 % less stool fragmentation but poorer stool deferment and more nocturnal leakage . However , there were no differences in the bowel function , continence score , and quality of life at 1 year . There were no differences in the anorectal manometry and endoanal ultrasound findings . Conclusions Coloplasty pouches result ed in more anastomotic leaks and minimal differences in bowel function . At present , the J-pouch remains the benchmark for routine clinical practice , and due care ( including defunctioning stoma ) should be exercised in situations requiring CP PURPOSE Sphincter-preserving surgery is technically feasible for many rectal cancers , but functional results are not well understood . Therefore , the purpose of this study was to develop an instrument to evaluate bowel function after sphincter-preserving surgery . METHODS A 41-item bowel function survey was developed from a literature review , expert opinions , and 59 patient interviews . An additional 184 patients who underwent sphincter-preserving surgery between 1997 and 2001 were asked to complete the survey and  quality -of-life instruments ( Fecal Incontinence Quality of Life , European Organization for Research and Treatment of Cancer QLQ 30/Colorectal Cancer 38 ) . A factor analysis of variance was performed . Test – retest reliability was evaluated , with 20 patients completing two surveys within a mean of 11 days . Validity testing was done with clinical variables ( gender , age , radiation , length of time from surgery ) , surgical variables ( procedure : local excision , low anterior resection , coloanal anastomosis ) , reconstruction ( J-pouch , straight ) , anastomosis ( h and sewn , stapled ) , and quality -of-life instruments . RESULTS The survey response rate was 70.1 percent ( 129/184 ) . Among the 127 patients with usable data , 67 percent were male , the median age was 64 ( range , 38–87 ) years , and the mean time for restoration of bowel continuity after sphincter-preserving surgery was 22.9 months . Patients had a median of 3.5  stools/day ( range , 0–30 ) , and 37 percent were dissatisfied with their bowel function . Patients experienced a median of 22 symptoms ( range , 7–32 ) , with 27 percent reported as severe , 37 percent as moderate , and 36 percent as mild . The five most common symptoms were incomplete evacuation ( 96.8 percent ) , clustering ( 94.4 percent ) , food affecting frequency ( 93.2 percent ) , unformed stool ( 92.8 percent ) , and gas incontinence ( 91.8 percent ) . The factor analysis identified 14 items that collapsed into three subscales : FREQUENCY ( α = 0.75 ) , DIETARY ( α = 0.78 ) , and SOILAGE ( α = 0.79 ) , with acceptable test – retest reliability for the three subscales and total score ( 0.62–0.87 ) . The instrument detected differences between patients with preoperative radiation ( n = 67 ) vs. postoperative radiation ( n = 15 ) vs. no radiation ( n = 45 ) ( P = 0.02 ) ; local excision ( n = 10 ) vs. low anterior resection ( n = 55 ) vs. coloanal anastomosis ( n = 62 ) ( P = 0.002 ) ; and h and sewn ( n = 18 ) vs. stapled anastomosis ( n = 99 ) ( P = 0.006 ) . The total score correlated with 4 of 4 Fecal Incontinence Quality of Life ( P < 0.01 ) and 9 of 17 European Organization for Research and Treatment of Cancer subscales ( all P < 0.01 ) . CONCLUSIONS Patients undergoing sphincter-preserving surgery for rectal cancer have impaired bowel function , and those treated with radiation , coloanal anastomoses , or h and sewn anastomoses have significantly worse function . This reliable and valid instrument should be used to prospect ively evaluate bowel function after sphincter-preserving surgery in patients undergoing rectal cancer therapy Purpose The aim of this study was to assess the voiding dysfunction  after rectal cancer surgery with total mesorectal excision ( TME ) .  Methods This was part of a prospect i ve study done in the rectal cancer patients who underwent surgery with TME between November 2006 and June 2008 . Consecutive uroflowmetry , post-voided residual volume , and a voiding question naire were performed at preoperatively and postoperatively . Results A total of 50 patients were recruited in this study , including 28 male and 22 female . In the comparison of the preoperative data with the postoperative 3-month data , a significant decrease in mean maximal flow rate , voided volume , and post-voided residual volume were found . In the comparison with the postoperative 6-month data , however only the maximal flow rate was decreased with statistical significance ( P=0.02 ) . In the comparison between surgical methods , abdominoperineal resection patients showed delayed recovery of maximal flow rate , voided volume , and post-voided residual volume . There was no significant difference in uroflowmetry parameters with advances in rectal cancer stage . Conclusions Voiding dysfunction is common after rectal cancer surgery but can be recovered in 6 months after surgery or earlier . Abdominoperineal resection was shown to be an unfavorable factor for postoperative voiding . Larger prospect i ve study is needed to determine the long-term effect of rectal cancer surgery in relation to male and female baseline voiding condition This article reports on patient‐reported sexual dysfunction and micturition symptoms following a r and omized trial of laparoscopic and open surgery for rectal cancer Introduction Following recto-sigmoid resection some patients may become faecally incontinent and remain so despite conservative treatment . This multicentre prospect i ve study assessed the use of sacral nerve stimulation ( SNS ) in this group . Methods All patients had more than or equal to 4 days of faecal incontinence for solid or liquid stools over a 21-day period following recto-sigmoid resection for colorectal carcinoma . The operation had to have been deemed curative . They had to have failed pharmacological and biofeedback treatment . Results Three male patients met these criteria . One had had a colo-anal and two a colo-rectal anastomosis for rectal carcinoma . All patients had intact internal and external anal sphincters . Two patients had a successful temporary stimulation period and proceeded to permanent implantation . Pre-operative symptom duration was 1 year in the permanently implanted patients . They were followed up for 12 months . SNS  improved the number of faecally incontinent episodes in both patients . Ability to defer was improved in both patients from 0–5 min to 5–15 min . The faecal incontinence-specific ASCRS quality of life assessment improved in all four subcategories . Conclusion This study demonstrates that SNS may be effective in the treatment of patients with faecal incontinence following recto-sigmoid resection if conservative treatment has failed Purpose This study evaluates the anorectal and genitourinary function of patients treated by preoperative short-term radiotherapy ( RT ) or chemoradiotherapy ( CRT ) followed by surgery and surgery alone for rectal cancer . Methods For this study , a total of 613 patients , who were identified from a prospect i ve rectal cancer data base , underwent anterior resection of the rectum between October 2001 and December 2007 . St and ardized question naires were used to determine fecal incontinence , urinary , and sexual function . Relevant clinical variables were evaluated using univariate and multivariate analyses . Independent predictors of functional outcome were identified by a binary logistic regression analysis . Results The data of 263 ( 43 % ) patients were available for analysis . On multivariate analysis , neoadjuvant RT ( P < 0.01 ) and low anterior resection ( LAR ) ( P = 0.049 ) were associated with fecal incontinence . In univariate analysis , fecal incontinence was linked to preoperative neoadjuvant treatment ( RT and /or CRT vs. LAR ) ( P < 0.01 ) . The hazard ratio for developing fecal incontinence was 3.3 ( 1.6–6.8 ) for patients who received RT . One hundred twenty-five patients ( 51.2 % ) experienced urinary incontinence following surgery , the majority of whom were female ( P < 0.01 ) . On univariate analysis , male sexual function was associated with age ( P < 0.01 ) , ASA class ( P = 0.01 ) and LAR ( P = 0.01 ) . Conclusion Multimodal therapy of low rectal cancer increases the incidence of fecal incontinence and negatively affects sexual function . The potential benefits of RT or CRT need to be balanced against the risk of increased bowel dysfunction when determining the appropriate treatment for individual patients with rectal cancer Background Existing scales for assessing faecal incontinence have not been vali date d against clinical assessment , or with regard to reproducibility . They also fail to take into account faecal urgency , and the use of antidiarrhoeal medications . Aims To establish the validity , and sensitivity to change , of existing scales and a newly design ed incontinence scale . Methods ( 1 ) Twenty three patients ( 21 females , median age 57 years ) were prospect ively evaluated by two independent clinical observers , using three established scales ( Pescatori , Wexner , American Medical Systems ) , a newly devised scale which also includes details about urgency and antidiarrhoeal drugs , and by a 28 day diary . ( 2 ) A further 10 female patients were assessed by the same scales before and after surgery for faecal incontinence . Results ( 1 ) Assessment s by two independent clinicians correlated well . All four scales and a diary card correlated highly and significantly with the clinical impression , with the new scale reaching the highest correlation ( r=0.79 , p<0.001 ) . ( 2 ) All except one score changed significantly in response to surgical treatment ; the new scale showed the greatest change , at the highest level of significance ( p=0.004 ) , and correlated best with the clinicians ’ assessment of change ( r=0.94 , p<0.001 ) . Conclusions Existing scales for the assessment of faecal incontinence correlate well with careful clinical impression of severity , and serve as useful and reproducible measures for comparison of patients and treatments . A newly devised scale has shown high clinical validity and utility AIMS Intraoperative neuromonitoring ( IONM ) aims to control nerve-sparing total mesorectal excision ( TME ) for rectal cancer in order to improve patients ' functional outcome . This study was design ed to compare the urogenital and anorectal functional outcome of TME with and without IONM of innervation to the bladder and the internal anal sphincter . METHODS A consecutive series of 150 patients with primary rectal cancer were analysed . Fifteen match pairs with open TME and combined urogenital and anorectal functional assessment at follow up were established identical regarding gender , tumour site , tumour stage , neoadjuvant radiotherapy and type of surgery . Urogenital and anorectal function was evaluated prospect ively on the basis of self-administered st and ardized question naires , measurement of residual urine volume and longterm-catheterization rate . RESULTS Newly developed urinary dysfunction after surgery was reported by 1 of 15 patients in the IONM group and by 6 of 15 in the control group ( p = 0.031 ) . Postoperative residual urine volume was significantly higher in the control group . At follow up impaired anorectal function was present in 1 of 15 patients undergoing TME with IONM and in 6 of 15 without IONM ( p = 0.031 ) . The IONM group showed a trend towards a lower rate of sexual dysfunction after surgery . CONCLUSIONS In this study TME with IONM was associated with significant lower rates of urinary and anorectal dysfunction . Prospect i ve r and omized trials are m and atory to evaluate the definite role of IONM in rectal cancer surgery Background Laparoscopic total mesorect 
    Output:
    
Sexual function is more commonly affected after rectal surgery than after urinary function .
The main cause of dysfunction is damage to pelvic nerves .
Sexual and bladder functional outcomes in females are less well reported .
Laparoscopic and robotic surgery allows better visualization of autonomic nerves and , therefore , more precise dissection and preservation .