New device could help improve outcomes of pelvic tumour surgeries

Sep 14 2016

Tumour surgery in the pelvis (urogenital and anal area) can lead to injuries of the regional nervous centre and therefore to bowel and bladder incontinence and sexual function disorders. This can dramatically influence the quality of life of those affected. A device used to measure nerve function could help. The first scientific tests at the Comprehensive Cancer Centre (CCC) of the Medical University of Vienna and the Vienna General Hospital show positive results.

In Austria, around 600 people undergo surgery for a tumour in the rectum every year. At the Vienna General Hospital and at the Medical University of Vienna alone, approximately 100 surgeries are performed in this area annually. Around 1,900 further procedures take place during this time period for cancer in the urogenital area. These pelvic surgeries can cause short, medium or long term irritation of the nerve centre. The consequences are bowel and bladder incontinence and sexual function disorders, such as erectile problems for men and vaginal dryness for women, a decline of swell ability in the genital area or pain during intercourse.

Béla Téleky, expert in neurosurgery from the Department of Surgery at the Medical University of Vienna and the Vienna General Hospital and a member of the CCC: "Nerve injury in this region can massively reduce the quality of life. Therefore we are constantly working to improve our surgical techniques. Initial tests with a device which measures nerve function before, during and after surgery, have shown promising results. As a first step, we now put the device in the area of the rectum during surgery (note: colorectum)."

Map of nerves

The reason why damage often occurs, is that the region of the pelvis is very narrow and the surgeon can often only poorly recognise the nerves because they are hidden. With the help of the device which has been used recently, nerves can be measured using electrical stimulation and a map of the neuroplexus and its paths can be created.

This process is called "neuromapping". Before surgery it can be established whether there are already disturbances of nerve function, e.g. caused by pre-treatment with chemotherapy or radiation, inflammation, tumour growth or metastasis. Thus, the surgery can be planned exactly or treatment decisions can be made in advance.

In this way, it is easier to assess if such preliminary damage or injuries to the sphincter makes a colostomy necessary to obtain quality of life or even life itself. This can then be achieved during surgery, whereby the patient is spared a second procedure. During surgery, the device allows nerve monitoring, whereby consequential damage can be minimised and after surgery the retention or the extent of function can be checked. The monitoring of nerve function is accomplished using probes as thin as acupuncture needles, which stimulate the nerves or measure the muscle contractions of the bladder and sphincter. A graph on a monitor makes the nerves visible and audible signals verify their stimulation and response.

Symposium "The aroused human"

The new process will also be part of the international symposium "The aroused human". This will take place on 14 and 15 September 2016 at the Medical University of Vienna and will highlight the impact of surgery on the arousal of neural structures, because this previously taboo subject is constantly gaining importance. Lucia Ucsnik, Department of Surgery at the Medical University of Vienna and the Vienna General Hospital, a member of the CCC and, together with Béla Téleky, organiser of the event: "Those men and women affected are now between 50 and 70 years and partly also younger. Unlike before, they do not want to accept the loss of a sexually active partnership and the impairment of private and professional lives through faecal or urinary incontinence. As physicians we needed, more than ever, to scientifically deal with these issues, to bring these topics out of the taboo zone and offer new solutions. Solutions that contribute to a high quality life are possible even during and after cancer treatment."

"The aroused human", 14 September, from 17:30 and 15 September from 9:00, Van Swieten Saal at the Medical University of Vienna, Van-Swieten-Gasse 1, 1090 Vienna.