Colorectal Cancer Unit, Department of Surgery, Zealand University Hospital, Roskilde, Sygehusvej 10, 4000, Roskilde, Denmark.
Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
World J Surg. 2019 Aug;43(8):2090-2098. doi: 10.1007/s00268-019-05010-1.
Early catheter removal is essential to enhance postoperative mobilization and recovery, but may carry a risk of urinary retention. This study aimed to evaluate a standardized regimen for early postoperative catheter removal and re-catheterization in patients undergoing elective laparoscopic colorectal cancer surgery within an optimal ERAS setting.
This was a single-center prospective study of patients undergoing elective minimally invasive colorectal resection and postoperative catheter removal within 24 h, with a re-catheterization threshold of 800 ml bladder volume. The primary outcome was postoperative urinary retention rate, and the secondary outcomes were time of catheter removal and length of stay with a special focus on differences between colon and rectal resections.
A total of 113 patients were included in the study, and 87 patients were eligible for the final analysis. Rectal resection was performed in 22 of 87 patients, and all operations were performed with minimally invasive technique. The conversion rate was 3.5%, and 30-day mortality was 0%. More than 95% of the patients had their catheter removed within 24 h with no difference between rectal and colonic resections. Postoperative urinary retention was observed in 9% of all patients (rectum 18% vs. colon 6%, p = 0.11). One patient had an indwelling catheter at discharge, but all patients had free voluntary micturition at 30-day follow-up. Median length of stay was 3 days (1-13 days).
Catheter removal within 24 h of surgery using a re-catheterization threshold of 800 ml is safe and reduces unnecessary re-catheterizations following minimally invasive colorectal resection.
早期拔除导尿管对于促进术后活动和康复至关重要，但可能会增加尿潴留的风险。本研究旨在评估在最佳 ERAS 环境下，对接受择期腹腔镜结直肠癌手术的患者实施标准化的术后早期导尿管拔除和再置管方案。
这是一项单中心前瞻性研究，纳入了接受微创结直肠切除术且术后 24 小时内拔除导尿管的患者，以膀胱容量达到 800ml 作为再置管阈值。主要结局为术后尿潴留发生率，次要结局为导尿管拔除时间和住院时间，特别关注结肠和直肠切除术之间的差异。
共纳入 113 例患者，其中 87 例患者符合最终分析标准。87 例患者中行直肠切除术 22 例，所有手术均采用微创技术进行。中转开腹率为 3.5%，30 天死亡率为 0%。超过 95%的患者在 24 小时内拔除导尿管，直肠和结肠切除术之间无差异。所有患者中术后尿潴留发生率为 9%（直肠 18%，结肠 6%，p=0.11）。1 例患者在出院时留置导尿管，但所有患者在 30 天随访时均能自由自主排尿。中位住院时间为 3 天（1-13 天）。
对于接受微创结直肠切除术的患者，术后 24 小时内使用 800ml 再置管阈值拔除导尿管是安全的，可减少不必要的再置管。
