Objective:Preservation of the pelvic autonomic nerves in order to lower bladder and sexual dysfunction after radical rectal cancer surgery & to evaluate functional outcome,local recurrence.Methods:A prospective study was undertaken on Egyptian patients.Forty one patients participated in the study in the period from December 2002 till June 2004 where they underwent radical surgery but with preservation of the pelvic autonomic nerves this was followed by adjuvant pelvic radiotherapy.Results:Six months,1-year and 2-year follow-up of urinary function was complete in 32 out of 41(78%),30 out of 41 (73%) and 27 out of 41 patients (65%) respectively There was no statistically significant correlation between the extent of nerve preservation and the reported minor voiding dysfunction.None of the patients reported major incontinence.Six months,1-year and 2-year follow-up of sexual function revealed that 22 out of 41 patients (53%) were sexually active.Three out of 41 patients (7.3%) developed local recurrence.38 (92.7%) patients were free of local recurrence,regarding patients who received adjuvant radiotherapy 3 out of the 34 (8.8%) patients developed local pelvic recurrence while 9 patients (26.5%) developed distant metastases (3 of them did not receive adjuvant chemotherapy),while patients who received adjuvant chemotherapy,2 out of 20 patients (10%) developed local recurrence while distant metastases developed in 6 patients (30%).Conclusion:Preservation of the pelvic autonomic nerves minimizes bladder and sexual dysfunction especially in male patients after rectal cancer surgery.