Urinary and sexual dysfunction in patients with rectal cancer following a watch and wait protocol – results from the Swedish national WoW study

Abstract Introduction Treatment for rectal cancer is associated with urinary and sexual dysfunction. Few studies describe urinary and sexual function after neoadjuvant (chemo)radiotherapy and a watch and wait (WoW) approach. This study aimed to evaluate the prevalence and change over time in patient-reported urinary and sexual dysfunction in patients within the Swedish watch and wait study. Method The Swedish Watch and Wait (WoW) study is a multicenter prospective cohort study including patients with clinical complete response (cCR) after (chemo)radiotherapy for rectal cancer. A total of 211 patients with cCR (stage I-III rectal cancer) were included between January 2017 and February 2023. Questionnaires were collected at baseline, 6 months, 1 year, and 2 years post-treatment. Result Questionnaire data were available for 173 patients at baseline and 136 at two years. The median age was 66 years (60% male). Neoadjuvant treatment was given as short-course radiotherapy (SCRT) (27.5%), SCRT combined with chemotherapy (66.5%), long-course chemoradiotherapy (4.9%) and other treatments (1.1%). Urinary incontinence during daytime increased from 9,2 % at baseline to 14,7% two years after treatment. Erectile dysfunction was stable: 24,0 % at baseline and 23,5 % at two years follow-up. In women, sexual function including arousal, lubrication and orgasm decreased during follow-up. Discussion Urinary and sexual dysfunction is seen in patients treated with neoadjuvant therapy without subsequent surgery. Urinary incontinence slightly increased during follow-up. Female sexual function decreased, whereas erectile dysfunction remained stable during follow-up. The results are encouraging but also indicate that dysfunction is present, albeit to a lesser extent than if surgery is part of the treatment.