Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2019 Jan;26(1):79-85. doi: 10.1245/s10434-018-6822-x. Epub 2018 Oct 23.
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.
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.
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.
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.
术后早期拔除导尿管可降低尿路感染（UTI）发生率并促进患者早期活动。本研究旨在评估结直肠癌根治术后第 1 天（POD1）拔除导尿管的效果。
回顾性分析了 469 例行结直肠癌根治术患者的前瞻性数据库，对所有 POD1 拔除导尿管的患者进行回顾性研究。对无法在导尿管拔除后 6 小时内自行排尿的患者进行留置导尿（IOC 组），并与能自行排尿的患者（非 IOC 组）进行比较，以确定 IOC 的危险因素。
共纳入 417 例患者，其中 274 例（66%）为男性，中位年龄为 59（50-68）岁。行腹会阴联合切除术（APR）的患者 134 例（32%），至少切除一个其他器官的复杂手术 72 例（17%）。非 IOC 组和 IOC 组分别有 245 例（59%）和 172 例（41%）患者。男性、肥胖、梗阻性尿路疾病史、APR 和转移性疾病是 IOC 的 5 个独立预测因素。在 POD1 时，无危险因素、有 1、2 和至少 3 个危险因素的患者 IOC 累积风险分别为 8%、31%、52%和 68%，在 POD5 时，其分别为 2%、12%、23%和 30%（p<0.001）。13 例（3%）患者发生 UTI。
结直肠癌根治术后第 1 天早期拔除导尿管，59%的患者可自行排尿，无需行 IOC。无预测因素的患者发生排尿功能障碍的风险小于 10%。
