Colorectal LLM Wiki

Browse
Home / Sources / ASCRS Ch64 - Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery
Source created 2026-08-27 · updated 2026-08-27
colorectalASCRSsexual-dysfunctionerectile-dysfunctionquality-of-lifeLGBTQ

ASCRS Ch64 - Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery

Chapter 64 of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition (Mantilla N, McNevin S). PDF pages 1053-1061, book pages 1067-1075 (offset +14, unchanged from Ch63 — confirmed via the "© Springer Nature Switzerland AG 2022 1067" copyright line on the chapter's first PDF page).

Offset jump discovered at the Ch64/Ch65 boundary: Ch64 ends on book page 1075, an odd page — per this wiki's offset-tracking rule (a new chapter starts on the next odd/recto page in print, forcing a blank page that's dropped from the PDF, which shows up as an offset jump only when the previous chapter ends on an odd page), this predicts a +1 jump to +15 at the Ch64/Ch65 boundary. Confirmed: Ch65 ("Middle and Anterior Pelvic Compartment: Issues for the Colorectal Surgeon") begins at PDF page 1062, book page 1077 (copyright line "© Springer Nature Switzerland AG 2022 1077") — offset +15, one more than Ch64's own +14. Fourth chapter-boundary offset jump found this ingest arc (after Ch59/Ch60, Ch60/Ch61, and now Ch64/Ch65), all following the same odd-ending- page mechanism.

Structure and content

The second of a paired set of chapters on sexual/genitourinary dysfunction after colorectal surgery (Ch63 covers female patients). Covers:

  • Introduction: prevalence of male genitourinary dysfunction after pelvic colon/rectal procedures estimated at 20-80%; contributors beyond direct nerve injury (radiotherapy, chemotherapy, psychological impact of long-term fecal diversion).
  • Neuroanatomy and physiology: detailed sympathetic (T12-L2, superior hypogastric plexus, hypogastric nerves — governing ejaculation) and parasympathetic (S2-S4, pelvic splanchnic nerves/nervi erigentes, inferior hypogastric plexus — governing erectile function) pathways, and the specific dysfunction each injury pattern produces (retrograde ejaculation vs. impotence vs. bladder atonia/dyssynergia).
  • Male genitourinary functional metrics: sexual dysfunction instruments (IIEF-15, IIEF-5/SHIM, EPIC) and urinary dysfunction instruments (UDI/UDI-6, King's Health Questionnaire, Danish Prostatic Symptom Score, ICS male questionnaires), per Pelvic Floor Disorders Consortium guidance.
  • Colorectal procedures resulting in genitourinary dysfunction: risk gradient by dissection depth (anterior resection lowest, APR highest and multifactorial), MIS-vs-open TME's limited/controversial comparative data, and pelvic radiotherapy's contribution.
  • Psychological impact and counseling: rapport-building, preoperative functional history, informed consent detail, postoperative active questioning and reassurance.
  • Management of male genitourinary dysfunction: a stepped ladder — vacuum constriction device, intracorporeal injections (alprostadil, Bimix, Trimix), intraurethral alprostadil, oral PDE5 inhibitors (less effective for neurogenic post-surgical ED specifically), penile prosthesis (inflatable vs. semirigid), retrograde ejaculation/anejaculation management (urine-harvested semen for assisted fertilization), and urinary retention management (indwelling catheter/alpha-blockade → chronic intermittent catheterization → long-term indwelling/suprapubic catheter).
  • LGBTQ populations: an extended, unusually candid section on gay/bisexual men (GBM) — mental health burden, relationship impact, role-change dynamics (insertive vs. receptive), the clinically- defined anodyspareunia syndrome (82% avoid anal sex, 49% restrict to insertive-only, 31% relationship disruption, 15% unable to form new partnerships), and the Gay Sexual Functioning Inventory (Rosser et al. 2019, Restore Study) — validated only in a prostate-cancer population, not yet in colorectal surgery patients.
  • Genitourinary dysfunction related to fecal diversion: stoma-specific quality-of-life data (80% lifestyle change, 40% impaired sexuality, elevated suicide risk in ostomates), independent of the nerve-injury mechanisms covered elsewhere in the chapter.

Wiki integration

Content merged into the existing Sexual Function After Colorectal Surgery concept page (created for Ch63) as a new "Male genitourinary dysfunction" top-level section, organized in parallel to the existing "Female sexual dysfunction" section. Light cross-reference additions to Abdominoperineal Resection (APR) (corroborating and contextualizing its APR-as-highest-risk open item) — Total Mesorectal Excision (TME) & Sphincter-Sparing Resection and General Postoperative Complications already cross-reference the concept page from the Ch63 pass and were not further edited.

Offset tracking

  • Chapter starts: PDF p.1053, book p.1067 (offset +14, confirmed via copyright line; unchanged from Ch63).
  • Chapter ends: book p.1075 (odd page) → +1 jump to +15 predicted and confirmed at the Ch64/Ch65 boundary.
  • Ch65 confirmed starting at PDF p.1062/book p.1077, offset +15 (copyright line verified).