Skip to main content

Advertisement

SpringerLink
Log in

Outcomes of Early Removal of Urinary Catheter Following Rectal Resection for Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Early postoperative urinary catheter removal decreases urinary tract infection (UTI) rate and accelerates patient mobilization. The aim of this study is to determine the results of systematic urinary catheter removal on postoperative day (POD) 1 in patients undergoing rectal resection for cancer.

Patients and Methods

Using a prospectively maintained database of 469 patients who underwent rectal resection for cancer, a retrospective review of all patients with urinary catheter removal on POD1 was conducted. Patients unable to void 6 h after catheter removal underwent in and out urinary catheterization (IOC group) and were compared with patients who voided spontaneously (non-IOC group) to determine risk factors for IOC.

Results

A total of 417 patients were identified, including 274 (66%) men. Median age was 59 (50–68) years. Abdominoperineal resection (APR) was performed in 134 (32%), and complex surgery with resection of at least one other organ in 72 (17%) patients. Non-IOC and IOC groups included 245 (59%) and 172 (41%) patients, respectively. Five independent predictive factors for IOC were male gender, obesity, history of obstructive urinary disease, APR, and metastatic disease. The cumulative risk of IOC in patients with zero, one, two, and at least three risk factors was 8%, 31%, 52%, and 68% on POD1, and 2%, 12%, 23%, and 30% on POD5, respectively (p < 0.001). Thirteen patients (3%) developed UTI.

Conclusions

Early removal of urinary catheter resulted in 59% of patients voiding spontaneously with no need for IOC following rectal resection. Patients without any predictive factors had less than 10% risk of urinary dysfunction.

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

Similar content being viewed by others

References

  1. Delacroix S, Winters JC. Voiding dysfunction after pelvic colorectal surgery. Clin Colon Rectal Surg. 2010;23:119–27.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bouchet-Doumenq C, Lefevre JH, Bennis M, et al. Management of postoperative bladder emptying after proctectomy in men for rectal cancer. A retrospective study of 190 consecutive patients. Int J Colorectal Dis. 2016;31:511–8.

    Article  PubMed  Google Scholar 

  3. Kin C, Rhoads KF, Jalali M, et al. Predictors of postoperative urinary retention after colorectal surgery. Dis Colon Rectum. 2013;56:738–46.

    Article  PubMed  Google Scholar 

  4. Lee SY, Kang S-B, Kim D-W, et al. Risk factors and preventive measures for acute urinary retention after rectal cancer surgery. World J Surg. 2015;39:275–82.

    Article  PubMed  Google Scholar 

  5. Kwaan MR, Lee JT, Rothenberger DA, et al. Early removal of urinary catheters after rectal surgery is associated with increased urinary retention. Dis Colon Rectum. 2015;58:401–5.

    Article  PubMed  Google Scholar 

  6. Grass F, Slieker J, Frauche P, et al. Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway. J Surg Res. 2017;207:70–6.

    Article  PubMed  Google Scholar 

  7. Zmora O, Madbouly K, Tulchinsky H, et al. Urinary bladder catheter drainage following pelvic surgery—is it necessary for that long? Dis Colon Rectum. 2010;53:321–6.

    Article  PubMed  Google Scholar 

  8. Kim HO, Cho YS, Kim H, et al. Scoring systems used to predict bladder dysfunction after laparoscopic rectal cancer surgery. World J Surg. 2016;40:3044–51.

    Article  PubMed  Google Scholar 

  9. Hoppe EJ, Main WP, Kelley SR, et al. Urinary retention following colorectal surgery. Am Surg. 2017;83:3–7.

    PubMed  Google Scholar 

  10. Benoist S, Panis Y, Denet C, et al. Optimal duration of urinary drainage after rectal resection: a randomized controlled trial. Surgery. 1999;125:135–41.

    Article  CAS  PubMed  Google Scholar 

  11. Wald HL, Ma A, Bratzler DW, et al. Indwelling urinary catheter use in the postoperative period. Arch Surg. 2008;143:551.

    Article  PubMed  Google Scholar 

  12. NCCN.org. NCCN clinical practice guidelines in oncology (NCCN guidelines)—rectal cancer. Version 22016. https://www.tri-kobe.org/nccn/guideline/colorectal/english/rectal.pdf. Accessed Jan 2018.

  13. Khreiss W, Huebner M, Cima RR, et al. Improving conventional recovery with enhanced recovery in minimally invasive surgery for rectal cancer. Dis Colon Rectum. 2014;57:557–63.

    Article  PubMed  Google Scholar 

  14. Vather R, Trivedi S, Bissett I. Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg. 2013;17:962–72.

    Article  PubMed  Google Scholar 

  15. Clavien PA, Barkun J, Oliveira ML de, et al. The Clavien–Dindo classification of surgical complications. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  16. Sheka AC, Tevis S, Kennedy GD. Urinary tract infection after surgery for colorectal malignancy: risk factors and complications. Am J Surg. 2016;211:31–9.

    Article  PubMed  Google Scholar 

  17. Morse BC, Boland BN, Blackhurst DW, et al. Analysis of centers for medicaid and medicare services “never events” in elderly patients undergoing bowel operations. Am Surg. 2010;76:841–5.

    PubMed  Google Scholar 

  18. Kang CY, Chaudhry OO, Halabi WJ, et al. Risk factors for postoperative urinary tract infection and urinary retention in patients undergoing surgery for colorectal cancer. Am Surg. 2012;78:1100–4.

    PubMed  Google Scholar 

  19. Masnick M, Morgan DJ, Sorkin JD, et al. Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States? Infect Control Hosp Epidemiol. 2017;38:1167–71.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Meddings J, Rogers MAM, Macy M, et al. Systematic review and meta-analysis: reminder systems to reduce catheter—associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis. 2010;51:550–60.

    Article  PubMed  Google Scholar 

  21. Saliba W, Fediai A, Edelstein H, et al. Trends in the burden of infectious disease hospitalizations among the elderly in the last decade. Eur J Intern Med. 2013;24:536–40.

    Article  PubMed  Google Scholar 

  22. Cek M, Tandoğdu Z, Wagenlehner F, et al. Healthcare-associated urinary tract infections in hospitalized urological patients—a global perspective: results from the GPIU studies 2003–2010. World J Urol. 2014;32:1587–94.

    Article  PubMed  Google Scholar 

  23. Yoo BE, Kye BH, Kim HJ, et al. Early removal of the urinary catheter after total or tumor-specific mesorectal excision for rectal cancer is safe. Dis Colon Rectum. 2015;58:686–91.

    Article  PubMed  Google Scholar 

  24. Baukloh JK, Reeh M, Spinoglio G, et al. Evaluation of the robotic approach concerning pitfalls in rectal surgery. Eur J Surg Oncol. 2017;43:1304–11.

    Article  CAS  PubMed  Google Scholar 

  25. Taieb S, Trillet-Lenoir V, Rambaud L, et al. Lhermitte sign and urinary retention. Cancer. 2002;94:2434–40.

    Article  CAS  PubMed  Google Scholar 

  26. Wu AK, Auerbach AD, Aaronson DS. National incidence and outcomes of postoperative urinary retention in the Surgical Care Improvement Project. Am J Surg. 2012;204:167–71.

    Article  PubMed  Google Scholar 

  27. Barry MJ, Fowler FJ, O’Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148:1549–57.

    Article  CAS  PubMed  Google Scholar 

  28. Brookes ST, Donovan JL, Wright M, et al. A scored form of the bristol female lower urinary tract symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. Am J Obstet Gynecol. 2004;191:73–82.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    E. Duchalais MD, PhD, David W. Larson MD, MBA, N. Machairas MD, K. L. Mathis MD, MS, E. J. Dozois MD & S. R. Kelley MD

Authors
  1. E. Duchalais MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David W. Larson MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Machairas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. L. Mathis MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. J. Dozois MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. R. Kelley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David W. Larson MD, MBA.

Ethics declarations

Funding

The Fondation SanTDige provided a Grant to E.D.

Disclosure

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duchalais, E., Larson, D.W., Machairas, N. et al. Outcomes of Early Removal of Urinary Catheter Following Rectal Resection for Cancer. Ann Surg Oncol 26, 79–85 (2019). https://doi.org/10.1245/s10434-018-6822-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6822-x

Keywords

Search

Navigation