Chinese consensus on Denonvilliers' fascia preserving total mesorectal excision (iTME) (2021 version) / 中华胃肠外科杂志

In 1982, total mesorectal excision(TME) was proposed by Professor R. J. Heald, which was a milestone-style for rectal cancer surgery. The concept of TME has reduced the local recurrence rate of mid-low rectal cancer (MLRC) significantly, thus becomes the gold standard for MLRC surgery. However, the incidence of urogenital dysfunction after TME remains high, among which urinary dysfunction reaches 30%-60%, and sexual dysfunction reaches 50%-70%. In recent years, studies have shown that the removal of Denonvilliers' fascia (DVF) during TME is an important cause of postoperative urination and sexual dysfunction. Therefore, DVF preserving total mesorectal excision (iTME) has been recognized by more and more surgical experts. On the basis of existing literature and clinical practice, we organize experts to discuss and vote, put forward recommendations for several issues of iTME, and finally formulate this expert consensus. The formulation of this consensus aims to increase surgeons' awareness of the value and functional protection of DVF during TME surgery, clarify the indications and contraindications of iTME, and standardize the procedure of iTME, so as to reduce postoperative urination and sexual dysfunction and improve the quality of life of patients with MLRC. The level of evidence and recommendation of this consensus is determined by Grading Recommendations, Assessment, Development and Evaluation (GRADE), and the consensus content is determined through expert voting and Delphi method.

Clinical Observation on 176 Cases of Sexual Dysfunction / 대한비뇨기과학회지

Sexual histories of 176 patients of the sexual dysfunctions, who visited Department of Urology of Chung-Ang University Hospital from May, l986 to Aug. l986, were reviewed and compared with findings of the diagnostic examinations. The results were as follows. 1. The erectile dysfunction was 92.6% and the ejaculatory dysfunction was 7.4%. Of the erectile dysfunctions, 58.2% was psychogenic and 4l.8% was organic. The most common etiology of the organic impotence was diabetes mellitus, followed by vascular, trauma, drug, neurogenic, and endocrinogenic in order. 2. Ages of 20 years was the most common, followed by ages of 30, 40, 50, 60 and 70 years in order Unmarraged single patients were 42.6%. 3. The patients whose living conditions and anxiety had influence on their sexual life were 27.3%, and the patients whose sexual problems had influence on their daily life or married life were 84.3 %. But the patients who had ever visited psychiatrists for sexual problems were only 8.6%. 4. Sexual desire of the patients was low, as compared with their ages, in 37.3%. The patients who never had sexual desire from their sexual partners were 24.3%. And indifference of their sexual partners to the patients or lack of their sexual desire was l8.4% or 21.8%. 5. Out of the 20 cases who was considered as definitely psychogenic impotent patients on the base of the sexual histories, 5 were proved to be organic by the diagnostic examinations. And out of 11 cases of organic impotences, 5 cases were turned out to be pychogenic. In conclusion, the fact that the patients of the sexual dysfunction were much more common in younger ages than expected, implies lack of sexual education and sexual knowledge with insufficient sexual expecience make them patients of the psychogenic sexual dysfunction. And the effects of sexual dysfunction on their daily life are very serious in most patients, particularly in the younger ages.