According to a study published in Colorectal Disease, many patients with rectal cancer report urinary dysfunction upon diagnosis as well as after treatment, with incontinence increasing twofold following treatment. Researchers indicated it is imperative to inform patients of the potential treatment-related functional impairments, to identify patients specifically at risk and to ensure a proper post treatment follow-up.
The investigators of this study sought to assess the prevalence of urinary dysfunction reported by patients at the time of rectal cancer diagnosis and at 1-year follow up post treatment, and to further evaluate risk factors for developing urinary incontinence.
The study included a total of 916 patients with newly diagnosed rectal cancer from the Quality of Life in Rectal Cancer (QoLiRECT) study between 2012 and 2015 who completed questionnaires both at the time of diagnosis and at the 1-year follow-up visit. The questionnaire enquired about demographic and lifestyle factors, quality of life, and urinary, bowel, sexual, and stoma function. Questions regarding urinary function (incontinence, bladder-emptying difficulties, urgency, and distress) and lifestyle (smoking, alcohol use, and physical activity) were analyzed, and results were compared by gender. The investigators also performed regression analyses to determine possible risk factors for urinary incontinence. Researchers compared the patient cohort from 16 Swedish and Danish hospitals with a general Swedish population cohort.
The prevalence of urinary dysfunction at baseline was higher among women than men in the patient cohort, in which 14% of women and 8% of men reported urinary dysfunction, at rates similar to the general population. At the 1-year follow up, 29% of women and 14% of men reported urinary incontinence, demonstrating a nearly twofold increase. Bladder-emptying difficulties were more prevalent among men (49%) compared with women (41%) at follow up, while the prevalence of reported urgency was 58% across both sexes. The proportion of men and women reporting distress about their urinary symptoms almost doubled from baseline to follow up, and preoperative urinary dysfunction and abdominoperineal excision independently predicted urinary incontinence at the 1-year follow up. In the patients who reported being continent at baseline, female sex, physical inactivity, comorbidity, and abdominoperineal excision were found to be risk factors for incontinence at follow up.
Limitations to the study included the observational design, which prevents the ability to infer causation, and that participants were required to have a good understanding of Swedish or Danish, which potentially limits the generalizability of the study findings.
Since urinary dysfunction is common among patients treated for rectal cancer, the researchers of the study concluded that few of the associated risk factors are modifiable and that clinicians should stress possible outcomes related to urinary dysfunction prior to patients receiving treatment for rectal cancer.
Karlsson L, Bock D, Asplund D, Ohlsson B, Rosenberg J, Angenete E. Urinary dysfunction in patients with rectal cancer: a prospective cohort study [published online July 23, 2019]. Colorectal Dis. doi: 10.1111/codi.14784