Powikłania proktologiczne u pacjentów leczonych z powodu raka prostaty

*Małgorzata Kołodziejczak¹, Tomasz Szopiński², Iwona Sudoł-Szopińska^{3, 4}

Summary
Prostate carcinoma is the second most common cancer in men in Poland. There has been a significant increase in the number of patients who can undergo radical cancer therapy, i.e. resection of the prostate or radiotherapy, due to the progress in cancer diagnostics. Each of these therapies involves the risk of various complications, including proctologic ones, which results from the fact that prostate and rectal wall are situated in immediate vicinity. Damage to the rectal wall during surgery can lead to the formation of abscess, rectal bladder fistula or rectourethral fistula, depending on the clinical course. Damage to the pelvic neural plexuses can cause the symptoms of stool and gas incontinence. Such functional disorders require conservative management (diet, behavioural training, biofeedback).
Furthermore, the close proximity of the rectum to the prostate and, after surgery, to the vesicourethral anastomosis, results in common complications occurring secondary to radical or adjuvant radiotherapy. Radiation can cause damage to the rectal mucosa and the associated bleeding, diarrhoea, frequent rectal tenesmus as well as stool and gas incontinence. Usually conservative therapy using different types of medications, such as sucralfate, metronidazole, mesalazine, sulfasalazin, steroids, is initiated. Surgical treatment in the form of an ostomy, resection of the rectum or rectum and prostate as well as, in exceptional cases, the urinary bladder, is only used in severe cases of radiation proctitis. Chemotherapy can cause diarrhoea and, consequently, rectal irritation and pruritus, which require symptomatic treatment. Patients with prostate carcinoma can also develop proctologic conditions which are independent of cancer. The method of treatment of these diseases depends on the overall condition and the immune status of the patient.
Conclusions. Proctologic complications associated with prostate cancer therapy significantly reduce the quality of life of patients. In most cases conservative therapy is used to reduce the symptoms, however, severe complications, such as rectal haemorrhage or rectal bladder fistula, require surgical treatment.

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