Acute urinary retention rates following early removal or no placement in colon and rectal surgery: a single-center analysis

Althoff, Ashley; Poulos, Constantine M.; Hale, Jennifer R.; Staff, Ilene; Vignati, Paul V.

doi:10.1007/s00464-021-08613-9

Cited by 5 publications

(9 citation statements)

References 17 publications

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“…Despite recommendations to remove the UC early, 43% of patients in our cohort still had a UC in place for >24 h. This is significantly more than the 24%-30% of UCs left in place reported in the literature [2,9]. We are unable to explain this difference; it highlights the importance of providing strong evidence in order to standardize practice and to manage the UC in the best manner possible, especially within the ERP setting.…”

Section: Discussioncontrasting

confidence: 61%

“…In this study, no comparison was made with a control group. In another recent cohort study, the authors assessed the rates of AUR in patients both with and without UCs in place during colon or rectal surgery [2]. Deferral or early removal of UCs was feasible and safe without an increased risk of AUR, but the rate of patients with no UC in place was <5% [2].…”

Section: What Does This Paper Add To the Literature?mentioning

confidence: 99%

“…Recent American guidelines recommend that, after colon or high rectum anastomoses, a urinary catheter (UC) should be removed 24 h following the procedure [1]. However, current practice varies widely and some studies point to the feasibility of UC abstention in colon surgery in the context of enhanced recovery programmes (ERPs) [2, 3].…”

Section: Introductionmentioning

confidence: 99%

“…However, they could also increase the risk of urinary tract infection (UTI). AUR is reported as a complication in 4%–22% of cases [4], while UTIs are reported in 1.4%‐4% of cases [2].…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, colon or high rectum anastomosis patients had UCs in place for up to 3 days after surgery, but ERPs now make it possible for patients to be fitted with fewer surgical drains [5]. Several studies have shown that short‐term placement of UCs does not increase the risk of AUR, whilst it does reduce the risk of UTIs in colon or high rectum anastomosis patients [2].…”

Section: Introductionmentioning

confidence: 99%

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Acute urinary retention and urinary tract infection after short‐course urinary drainage in colon or high rectum anastomoses: Post hoc analysis of a multicentre prospective database from the GRACE group

et al. 2022

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Aim:The aim was to define the risk factors for acute urinary retention (AUR) and urinary tract infections (UTIs) in colon or high rectum anastomosis patients based on the absence of a urinary catheter (UC) or the early removal of the UC (<24 h).Method: This is a multicentre, international retrospective analysis of a prospective database including all patients undergoing colon or high rectum anastomoses. Patients were part of the enhanced recovery programme audit, developed by the Francophone Group for Enhanced Recovery after Surgery, and were included if no UC was inserted or if a UC was inserted for <24 h.Results: In all, 9389 patients had colon or high rectum anastomoses using laparoscopy, open surgery or robotic surgery. Among these patients, 4048 were excluded because the UC was left in place >24 h (43.1%) and 97 were excluded because the management of UC was unknown (1%). Among the 5244 colon or high rectum anastomoses patients included, AUR occurred in 5.2% and UTI occurred in 0.7%. UCs were in place for <24 h in 2765 patients (52.7%) and 2479 did not have UCs in place (47.3%). Multivariate analysis showed that management of the UC was not significantly associated with the occurrence of AUR and that risk factors for AUR were male gender, ≥65 years old, having an American Society of Anesthesiologists score ≥3 and receiving epidural analgesia. Conversely, being of male gender was a protective factor of UTI, while being ≥65 years old, having open surgery and receiving epidural analgesia were risk factors for UTIs. The management of the UC was not significantly associated with the occurrence of UTIs but the occurrence of AUR was a more significant risk factor for UTIs. Conclusion:UCs in place for <24 h did not reduce the occurrence of AUR or UTI compared to the absence of UCs.

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Section: Discussioncontrasting

confidence: 61%

Section: What Does This Paper Add To the Literature?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…However, they could also increase the risk of urinary tract infection (UTI). AUR is reported as a complication in 4%–22% of cases [4], while UTIs are reported in 1.4%‐4% of cases [2].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute urinary retention and urinary tract infection after short‐course urinary drainage in colon or high rectum anastomoses: Post hoc analysis of a multicentre prospective database from the GRACE group

et al. 2022

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Immediate urinary catheter removal after colorectal surgery with the enhanced recovery after surgery protocol

Kim

Lee

Bae

et al. 2023

Int J Colorectal Dis

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Immediate versus early (24-hours) urinary catheter removal after elective minimally invasive colonic resection: study protocol for a randomized, multicenter, non-inferiority trial

Pedrazzani

Montroni

Conti

et al. 2022

Trials

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Background Enhanced Recovery After Surgery (ERAS) represents the standard of care in colorectal surgery. Among ERAS items, early removal of urinary catheter (UC) is considered a key issue, though adherence to this specific item still varies among centers. UC placement allows for monitoring of post-operative urinary output but relates to an increased risk of urinary tract infection (UTI), reduced mobility, and patient’s discomfort. Several studies investigated the role of early UC removal specifically looking at the rate of acute urinary retention (AUR) but most of them were retrospective, single-center, underpowered, cohort studies. The main purpose of this study is to compare the rate of AUR after immediate (at the end of the surgery) versus early (within 24 h from the completion of surgery) removal of UC in patients undergoing minimally invasive colonic resection (MICR). The secondary outcomes focus on goals that could be positively impacted by the immediate removal of the UC at the end of the surgery. In particular, the rate of UTIs, perception of pain, time-to-return of bowel and physical functions, postoperative complications, and length of hospital stay will be measured. Methods This is a prospective, randomized, controlled, two-arm, multi-center, study comparing the rate of AUR after immediate versus early removal of UC in patients undergoing MICR. The investigators hypothesize that immediate UC removal is non-inferior to 24-h UC removal in terms of AUR rate. Randomization is at the patient level and participants are randomized 1:1 to remove their UC either immediately or within 24 h from the completion of surgery. Those eligible for inclusion were patients undergoing any MICR with an anastomosis above the peritoneal reflection. Those patients who need to continue urinary output monitoring after the surgery will be excluded. The number of patients calculated to be enrolled in each group is 108 based on an expected AUR rate of 3% for the 24-h UC removal group and considering acceptable an AUR of 9% for the immediate UC removal group. Discussion The demonstration of a non-inferiority of immediate versus 24-h removal of UC would call into question the usefulness of urinary drainage in the setting of MICR. Trial registration ClinicalTrials.gov NCT05249192. Prospectively registered on February 21, 2022.

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Acute urinary retention rates following early removal or no placement in colon and rectal surgery: a single-center analysis

Cited by 5 publications

References 17 publications

Acute urinary retention and urinary tract infection after short‐course urinary drainage in colon or high rectum anastomoses: Post hoc analysis of a multicentre prospective database from the GRACE group

Acute urinary retention and urinary tract infection after short‐course urinary drainage in colon or high rectum anastomoses: Post hoc analysis of a multicentre prospective database from the GRACE group

Immediate urinary catheter removal after colorectal surgery with the enhanced recovery after surgery protocol

Immediate versus early (24-hours) urinary catheter removal after elective minimally invasive colonic resection: study protocol for a randomized, multicenter, non-inferiority trial

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