Skip to main content
SpringerLink
Log in

Optimal timing of urinary catheter removal following pelvic colorectal surgery: a systematic review and meta-analysis

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Acute urinary retention (AUR) is a common postoperative complication in colorectal surgery. In pelvic colorectal operations, the optimal duration for postoperative urinary catheter use is controversial. This systematic review and meta-analysis aims to compare early (POD 1), intermediate (POD 3), and late (POD 5) urinary catheter removal.

Methods

Medline, EMBASE, CENTRAL, and PubMed databases were searched. Articles were eligible for inclusion if they compared patients with urinary catheter removal on POD 1 or earlier to patients with urinary catheter removal on POD 2 or later in major pelvic colorectal surgeries. The primary outcome was rate of postoperative AUR. The secondary outcome was rates of postoperative urinary tract infection (UTI).

Results

From 691 relevant citations, five studies with 928 patients were included. Comparison of urinary catheter removal on POD 1 versus POD 3 demonstrated no significant difference in rate of urinary retention (RR 1.36, 95%CI 0.83–2.21, P = 0.22); however, compared to POD 5, rates of AUR were significantly higher (RR 2.58, 95%CI 1.51–4.40, P = 0.0005). Rates of UTI were not significantly different between POD 1 and POD 3 urinary catheter removal (RR 0.40, 95%CI 0.05–3.71, P = 0.45), but removal on POD 5 significantly increased risk of UTI compared to POD 1 (RR 0.50, 95%CI 0.31–0.81, P = 0.005).

Conclusion

Risk of AUR can be minimized with late postoperative urinary catheter removal compared to early removal, but at the cost of increased risk of UTI. Patient-specific factors should be taken into consideration when deciding upon optimal duration of postoperative urinary catheterization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kin C, Rhoads KF, Jalali M, Shelton AA, Welton ML (2013) Predictors of postoperative urinary retention after colorectal surgery. Dis Colon Rectum 56(6):738–746

    Article  Google Scholar 

  2. Slors FJ, van Zuijlen PP, van Dijk GJ (2000) Sexual and bladder dysfunction after total mesorectal excision for benign diseases. Scand J Gastroenterol Suppl (232):48–51

  3. Kang S-B, Park JW, Jeong S-Y, Nam BH, Choi HS, Kim D-W, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645

    Article  Google Scholar 

  4. Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Feldman LS, Steele SR (2017) Clinical practice guidelines for enhanced recovery after Colon and Rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 60:761–784

    Article  Google Scholar 

  5. Benoist S, Panis Y, Denet C, Mauvais F, Mariani P, Valleur P (1999) Optimal duration of urinary drainage after rectal resection: a randomized controlled trial. Surgery. 125(2):135–141

    Article  CAS  Google Scholar 

  6. Zmora O, Madbouly K, Tulchinsky H, Hussein A, Khaikin M (2010) Urinary bladder catheter drainage following pelvic surgery - is it necessary for that long? Dis Colon Rectum 53(3):321–326

    Article  Google Scholar 

  7. Yoo BE, Kye BH, Kim HJ, Kim G, Kim JG, Cho HM (2015) Early removal of the urinary catheter after total or tumor-specific mesorectal excision for rectal cancer is safe. Dis Colon Rectum 58(7):686–691

    Article  Google Scholar 

  8. Lee SY, Kang SB, Kim DW, Oh HK, Ihn MH (2015) Risk factors and preventive measures for acute urinary retention after rectal cancer surgery. World J Surg 39(1):275–282

    Article  Google Scholar 

  9. Patel DN, Felder SI, Luu M, Daskivich TJ, Zaghiyan NK, Fleshner P (2018) Early urinary catheter removal following pelvic colorectal surgery. Dis Colon Rectum 61(10):1180–1186

    Article  Google Scholar 

  10. Moher D, Liberati ATJ, AD. The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269

    Article  Google Scholar 

  11. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Br Med J 343:d5928

    Article  Google Scholar 

  12. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  Google Scholar 

  13. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14(1):135

    Article  Google Scholar 

  14. Lau J (2006) The case of the misleading funnel plot. BMJ. 333(7568):597–600

    Article  Google Scholar 

  15. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ Br Med J 327(7414):557–560

    Article  Google Scholar 

  16. Klevens RM, Edwards JR, Richards CL, Horan TC, Gaynes RP, Pollock DA et al (2007) Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 122:160–166

    Article  Google Scholar 

  17. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, Gutierrez JM, Frogley SJ, Ibele AR, Brinton EA, Hopkins PN, McKinlay R, Simper SC, Hunt SC (2017) Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med 377(12):1143–1155

    Article  Google Scholar 

  18. Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Mills S et al Risk factors for postoperative urinary tract infection and urinary retention in patients undergoing surgery for colorectal Cancer

  19. Agrawal K, Majhi S, Garg R (2019) Post-operative urinary retention: review of literature. World J Anesthesiol 8(1):1–12

    Article  Google Scholar 

  20. Zelmanovich A, Fromer DL (2018) Urinary retention after orthopedic surgery: identification of risk factors and management. J Clin Exp Orthop 04(01)

  21. Lee KS, Lim KH, Kim SJ, Choi HJ, Noh DH, Lee HW, Cho MC (2011) Predictors of successful trial without catheter for postoperative urinary retention following non-urological surgery. Int Neurourol J 15(3):158–165

    Article  Google Scholar 

  22. Coyle D, Joyce KM, Garvin JT, Regan M, McAnena OJ, Neary PM et al (2015) Early post-operative removal of urethral catheter in patients undergoing colorectal surgery with epidural analgesia - a prospective pilot clinical study. Int J Surg 16(Part A):94–98

    Article  Google Scholar 

  23. Stubbs BM, Badcock KJM, Hyams C, Rizal FE, Warren S, Francis D (2013) A prospective study of early removal of the urethral catheter after colorectal surgery in patients having epidural analgesia as part of the enhanced recovery after surgery programme. Color Dis 15(6):733–736

    Article  CAS  Google Scholar 

  24. Heald RJ, Moran BJ, Brown G, Daniels IR (2004) Optimal total mesorectal excision for rectal cancer is by dissection in front of Denonvilliers’ fascia. Br J Surg 91(1):121–123

    Article  CAS  Google Scholar 

  25. Meddings J, Skolarus TA, Fowler KE, Bernstein SJ, Dimick JB, Mann JD, Saint S (2019) Michigan appropriate perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA appropriateness method. BMJ Qual Saf 28(1):56–66

    Article  Google Scholar 

  26. Zhao Y, Hou X, Zhao Y, Feng Y, Zhang B, Zhao K (2017) Risk factors of postoperative urinary retention after rectal cancer surgery. Zhonghua Wei Chang Wai Ke Za Zhi 20(3):295–299

    PubMed  Google Scholar 

  27. Chaudhri S, Maruthachalam K, Kaiser A, Robson W, Pickard RS, Horgan AF (2006) Successful voiding after trial without catheter is not synonymous with recovery of bladder function after colorectal surgery. Dis Colon Rectum 49(7):1066–1070

    Article  Google Scholar 

  28. Tekkis PP, Cornish JA, Remzi FH, Tilney HS, Strong SA, Church JM, Lavery IC, Fazio VW (2009) Measuring sexual and urinary outcomes in women after rectal cancer excision. Dis Colon Rectum 52(1):46–54

    Article  CAS  Google Scholar 

  29. Kim KW, Lee J-I, Kim JS, Lee Y-J, Choi W-J, Jung H, Park KY, Park CH, Son KH (2015) Risk factors for urinary retention following minor thoracic surgery. Interact Cardiovasc Thorac Surg 20(4):486–492

    Article  Google Scholar 

  30. Patel JA, Kaufman AS, Howard RS, Rodriguez CJ, Jessie EM (2015) Risk factors for urinary retention after laparoscopic inguinal hernia repairs. Surg Endosc 29(11):3140–3145

    Article  Google Scholar 

  31. Blair AB, Dwarakanath A, Mehta A, Liang H, Hui X, Wyman C, Ouanes JPP, Nguyen HT (2017) Postoperative urinary retention after inguinal hernia repair: a single institution experience. Hernia. 21(6):895–900

    Article  CAS  Google Scholar 

  32. Alyami M, Lundberg P, Passot G, Glehen O, Cotte E (2016) Laparoscopic colonic resection without urinary drainage: is it “feasible”? J Gastrointest Surg 20(7):1388–1392

    Article  CAS  Google Scholar 

  33. Varadhan KK, Neal KR, Dejong CHC, Fearon KCH, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Yung Lee and Tyler McKechnie are joint first authors, contributed equally

Authors and Affiliations

  1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

    Yung Lee & Tyler McKechnie

  2. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada

    Yung Lee, Tyler McKechnie, Jeremy E. Springer, Aristithes G. Doumouras, Dennis Hong & Cagla Eskicioglu

  3. Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada

    Aristithes G. Doumouras, Dennis Hong & Cagla Eskicioglu

  4. Division of General Surgery Department of Surgery, St. Joseph’s Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada

    Cagla Eskicioglu

Authors
  1. Yung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tyler McKechnie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeremy E. Springer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aristithes G. Doumouras
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dennis Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cagla Eskicioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design–E, H, M, L.

Acquisition of data–M, L.

Analysis and interpretation of data–all authors.

Drafting of manuscript–D, S, M, L.

Critical revision of the manuscript for intellectual content–all authors.

Final approval of version to be published–all authors.

Corresponding author

Correspondence to Cagla Eskicioglu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Table 5 Complete search strategy (Medline database example)
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, Y., McKechnie, T., Springer, J.E. et al. Optimal timing of urinary catheter removal following pelvic colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis 34, 2011–2021 (2019). https://doi.org/10.1007/s00384-019-03404-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-019-03404-0

Keywords

Search

Navigation