Imaizumi Ken, Tsukada Yuichiro, Komai Yoshinobu, Nomura Shogo, Ikeda Koji, Nishizawa Yuji, Sasaki Takeshi, Taketomi Akinobu, Ito Masaaki
Department of Colorectal Surgery, National Cancer Centre Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
Int J Colorectal Dis. 2019 Aug;34(8):1431-1443. doi: 10.1007/s00384-019-03333-y. Epub 2019 Jul 6.
Postoperative urinary retention is a common adverse effect after rectal surgery. Current methods for assessing postoperative urinary retention (residual urine volume) are inaccurate and unable to predict long-term retention. Voiding efficiency is an effective indicator of postoperative urinary retention in urological and gynaecological fields, but not in colorectal surgery. We aimed to determine whether voiding efficiency in the initial 24 h after urinary catheter removal was more effective in predicting the incidence of postoperative urinary retention than residual urine volume.
In this retrospective, observational study using prospectively collected data from patients who visited the colorectal department of a single institution, 549 patients who underwent rectal cancer surgery between April 2012 and May 2016 were initially enrolled, of which 46 were excluded and 503 finally included.
The incidence of postoperative urinary retention was 18.5% (93/503). Multivariable logistic regression analyses revealed that the association of postoperative urinary retention with voiding efficiency < 50% was stronger than that with residual urine volume > 100 mL (odds ratio, 38.30 (residual urine volume) and 138.0 (voiding efficiency)). Voiding efficiency was significantly lower in patients with long-term than in those with short-term postoperative urinary retention (adjusted p value = 0.02), whereas residual urine volume was not different between the two groups. Multivariable logistic regression analysis for long-term postoperative urinary retention showed the strongest association with voiding efficiency < 20% (odds ratio, 25.70).
Voiding efficiency is a more effective predictor of postoperative urinary retention than residual urine volume in rectal cancer patients.
术后尿潴留是直肠手术后常见的不良反应。目前评估术后尿潴留（残余尿量）的方法不准确，且无法预测长期尿潴留情况。排尿效率是泌尿外科和妇科领域术后尿潴留的有效指标，但在结直肠手术中并非如此。我们旨在确定拔除尿管后最初24小时内的排尿效率在预测术后尿潴留发生率方面是否比残余尿量更有效。
在这项回顾性观察研究中，我们使用了从一家机构的结直肠科前瞻性收集的患者数据，最初纳入了2012年4月至2016年5月期间接受直肠癌手术的549例患者，其中46例被排除，最终纳入503例。
术后尿潴留的发生率为18.5%（93/503）。多变量逻辑回归分析显示，术后尿潴留与排尿效率<50%的关联比与残余尿量>100 mL的关联更强（比值比，残余尿量为38.30，排尿效率为138.0）。长期术后尿潴留患者的排尿效率显著低于短期患者（校正p值 = 0.02），而两组之间的残余尿量没有差异。对长期术后尿潴留的多变量逻辑回归分析显示，与排尿效率<20%的关联最强（比值比，25.70）。
对于直肠癌患者，排尿效率比残余尿量更能有效预测术后尿潴留。
