Kwaan Mary R, Lee Janet T, Rothenberger David A, Melton Genevieve B, Madoff Robert D
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Dis Colon Rectum. 2015 Apr;58(4):401-5. doi: 10.1097/DCR.0000000000000317.
Urinary retention after rectal resection is common and managed prophylactically by prolonging urinary catheterization. However, because indwelling urinary catheterization is a well-established risk factor for urinary tract infection, the ideal timing for urinary catheter removal following a rectal resection is unknown.
We hypothesized that early urinary catheter removal (on or before postoperative day 2) would be associated with urinary retention.
This study is a retrospective review of medical records.
This study was conducted at a colorectal surgery service at a tertiary care academic teaching hospital.
Adults undergoing rectal resection operations by colorectal surgeons in 2005 to 2010 were selected.
The primary outcome measured was urinary retention.
Of 205 patients included, 41 (20%) developed urinary retention. Male sex (OR, 3.9; 95% CI, 1.7-9), increased intraoperative intravenous fluid (OR for each liter, 1.2; 95% CI, 1.04-1.48), and urinary catheter removal on postoperative day 2 or earlier (OR, 3.8; 95% CI, 1.4-10.5) were associated with urinary retention on multivariable analysis. Early catheter removal was not associated with decreased urinary tract infection rates (p = 0.29) but was associated with shorter length of stay (6.5 vs 8.9 days; p = 0.005).
The retrospective nature of this study did not allow for a precise definition of urinary retention. Preoperative urinary function was not available, and the patient sample was heterogeneous, including several indications for rectal resection. Urinary catheters were not removed per protocol and therefore subject to bias. The study is likely underpowered to detect differences in urinary tract infection between urinary catheter removal groups.
In patients undergoing rectal resection, we found that urinary catheter removal on or before postoperative day 2 was associated with urinary retention (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A172).
直肠切除术后尿潴留很常见，通常通过延长导尿时间进行预防性处理。然而，由于留置导尿是尿路感染的一个既定危险因素，直肠切除术后拔除导尿管的理想时机尚不清楚。
我们假设早期拔除导尿管（术后第2天或之前）会与尿潴留相关。
本研究是对病历的回顾性分析。
本研究在一家三级医疗学术教学医院的结直肠外科进行。
选取2005年至2010年由结直肠外科医生进行直肠切除手术的成年人。
测量的主要结局是尿潴留。
在纳入的205例患者中，41例（20%）发生尿潴留。多变量分析显示，男性（比值比[OR]，3.9；95%置信区间[CI]，1.7 - 9）、术中静脉输液量增加（每升的OR，1.2；95% CI，1.04 - 1.48）以及术后第2天或更早拔除导尿管（OR，3.8；95% CI，1.4 - 10.5）与尿潴留相关。早期拔除导尿管与尿路感染率降低无关（p = 0.29），但与住院时间缩短有关（6.5天对8.9天；p = 0.005）。
本研究的回顾性性质不允许对尿潴留进行精确界定。术前尿功能情况不可得，且患者样本具有异质性，包括多种直肠切除的适应证。导尿管并非按照方案拔除，因此存在偏倚。该研究可能缺乏足够的检验效能来检测导尿管拔除组之间尿路感染的差异。
在接受直肠切除手术的患者中，我们发现术后第2天或之前拔除导尿管与尿潴留相关（见视频，补充数字内容1，http://links.lww.com/DCR/A172）。
