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Introduction  The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy. Method  Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C). Results  More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream – 13% vs 38%, P = 0.001 and 21% vs 21%, P = NS; incontinence – 4.2% vs 17%, P = 0.008 and 8% vs 8%, P = NS; hesitancy – 13% vs 35%, P = 0.034 and 17% vs 21%, P = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men – 62.5%, women – 25% vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision – 50% vs segmental colectomy – 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy. Conclusion  More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorial. [ABSTRACT FROM AUTHOR]