Urinary dysfunction may result from damage to the nerve supply during pelvic dissection or by the anatomical changes created by altering the physical structure of the pelvis. This problem may occur after appropriate oncologic resection of rectal cancer adhering to the globally accepted tenets of total mesorectal excision with either anterior resection or abdominoperineal resection. The most frequent type of urinary dysfunction is urinary retention, a transient problem which occurs in up to 25 % of men and 15 % of women. Fortunately, more severe chronic dysfunctions including voiding difficulty and incontinence are less common. Laparoscopy may confer a protective benefit although definitive evidence of a lower rate of dysfunction as compared to laparotomy remains elusive.