Clinical and Physiologic Characteristics of Rectal Prolapse in Males

This study compares the sexual differences among rectal prolapse patients regarding the clinical and the physiologic characteristics with emphasis on males. METHODS: The clinical data, functional status and operative records of 43 patients, who had completed both clinical and functional evaluations were collected in a prospective database and were analyzed according to sex. The functional status of the patients was evaluated by Wexner's constipation score (0~30), Wexner's incontinence score (0~20), anorectal manometry, and pudendal nerve terminal motor latency (PNTML). RESULTS: The incidences of rectal prolapse in males (n=22) and in females (n=21) were similar. The age of onset for males was lower (mean standard deviation, 19.6 19.59 (50% in childhood) vs 52.0 20.75 years; p=0.001) and the duration of symptoms was longer (31.5+/-19.87 vs 12.5+/-14.31 years; p<0.001). Surgery in males was most commonly performed during the sexually active years (51.2+/-16.34 vs 64.5+/-13.19; p=0.006). The incidence of mucosal prolapse in males was higher (10/22 vs 4/17; p=0.065). The incidences and the severities of defecation difficulty in males and females were similar (n=12, mean Wexner score=8.4 vs n=12, mean Wexner score=9.9; p=NS) but, the incidences and the severities of fecal incontinence were lower in males (n=4, mean Wexner score=4.3 vs n=17, mean Wexner score= 14.2; p<0.001). The maximum resting pressure was higher in males (39.2+/-21.46 vs 26.3+/-19.98 mmHg; p=0.049), and the maximum squeezing pressure was better preserved (131.2+/-62.63 vs 67.5+/-37.99 mmHg; p<0.001). No significant difference existed in the PNTML. Female patients underwent abdominal resection rectopexy (n=6), perineal rectosigmoidectomy with lavatoroplasty (n=11), and Delorme's procedure (n=4), but all male patients preferred the perineal approach (rectosigmoidectomy with lavatoroplasty (n=8), Delorme's procedure (n=14)) for fear of sexual dysfunction after the abdominal approach. CONCLUSIONS: These findings suggest that the mechanism for developing rectal prolapse in male and female may be different and that surgical treatment should be tailored to the patient.

Rectal Carcinoid

PURPOSE: This study was designed to evaluate the clinical charateristics, surgical treatment and outcome of carcinoid tumors of the rectum. METHODS: A retrospective review of the charts of all patients treated for rectal carcinoid tumors at Kangbuk Samsung Medical Center between Jan 1989 and April 1998. Thirteen patients with rectal carcinoids tumors were treated. Follow-up data, histopathological information and surgical procedures were obtained from case notes. RESULTS: There were 10 men and 3 women. The ages ranged from 28 to 60 years (mean 41.1 years for all, 43.8 years for men and 32 years for women). Eight patients (61.5%) had no symptoms. Of the five patients, four complained of rectal bleeding (30.8%), and one complained of defecational difficulty (7.7%). Size of rectal carcinoid tumor was less than 1 cm in 7 patients (53.8%), between 1 cm and 2 cm in 2 patients (15.4%), in four patients (30.8%) larger than 2 cm. Three patients were treated in Abdominoperineal resection. Two patients underwent stapled low anterior resection. The remaining 8 patients underwent conservative resection (3 colonoscopic polypectomy and electrocauterization, 2 colonoscopic snaring biopsy, 2 transanal resection and one Mason's operation). The depth of invasion was contained within sutmucosa in 3 patients. Liver metastasis was found in 2 patients. Average follow-up time was 35.6 months. Two patients died of mutiple mestastasis (liver, bone, peritoneum) 9 and 30months later. CONCLUSION: We concluded that tumors smaller than 1 cm could be managed by local treatment whereas larger than 2 cm should be managed by radical treatment.