During total mesorectal excision (TME) for rectal cancer, injury to the hypogastric nerve plexus at the level of the sacral promontory most commonly results in which specific dysfunction?

• A Bladder atony and urinary retention
• B Erectile dysfunction
• C Faecal incontinence
• D Retrograde ejaculation and bladder neck dysfunction ✓

Explanation

The superior hypogastric plexus (presacral nerves) at the sacral promontory carries sympathetic fibres; injury here causes retrograde ejaculation (failure of bladder neck closure during orgasm) and sympathetic bladder dysfunction. Erectile dysfunction is more related to injury of the inferior hypogastric plexus/pelvic splanchnic nerves (parasympathetic) lateral to the rectum. TME demands sharp dissection in the 'holy plane' to preserve these structures.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.