Optimal duration of urinary drainage after rectal resection: a randomized controlled trial.

BACKGROUND

Voiding dysfunction is frequently observed after rectal resection and justifies urinary drainage. However, there is no agreement about the optimal duration of this postoperative drainage. The aim of this controlled trial was to compare 1 versus 5 days of transurethral catheterization after rectal resection, with special reference to urinary tract infection and bladder retention.

METHODS

One hundred twenty-six patients undergoing rectal resection were included in a prospective randomized study designed to compare the results for patients undergoing 1 day of transurethral catheterization after rectal resection (1-day group) with those for patients undergoing 5 days' catheterization (5-day group).

RESULTS

Patients were randomly assigned to the 1-day and 5-day groups (n = 64 and 62, respectively). Clinical findings and surgical procedures were comparable in both groups. Acute urinary retention occurred in 16 patients (25%) in the 1-day group versus 6 (10%) in the 5-day group (P < .05). Urinary tract infection was observed in 13 of 64 patients (20%) in the 1-day group versus 26 of 62 (42%) in the 5-day group (P < .01). Multivariate analysis revealed that after 1 day of catheterization carcinoma of the low rectum and lymph node metastasis were significant risk factors for acute urinary retention (P < .05 for both factors). After selection of patients without low rectum carcinoma, the acute urinary retention rate was comparable in both groups (14% in the 1-day group versus 7% in the 5-day group), but the urinary tract infection rate was significantly lower in the 1-day group versus the 5-day group (14% vs 40, P < .01).

CONCLUSIONS

Our controlled study showed that after rectal resection 1 day of urinary drainage can be recommended for most patients. Five-day drainage should be reserved for patients with low rectal carcinoma.