Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
Dig Surg. 2022;39(2-3):75-82. doi: 10.1159/000522229. Epub 2022 Feb 7.
The incidence and clinical significance of postoperative urinary retention (POUR) remain high. This study aimed to evaluate the incidence of POUR and related risk factors in patients who underwent total mesorectal excision (TMR) for low rectal cancer.
This study is a retrospective review of a prospectively collected colorectal database from a single center. Data from patients who underwent surgery for low rectal cancer between September 2006 and May 2017 were analyzed to assess the risk factors of POUR. POUR was considered inability to void after urinary catheter removal requiring catheter reinsertion and difficulty in bladder emptying requiring intermittent catheterization.
Of 555 patients with low rectal cancer, 78 (14.1%) developed POUR. Based on multivariate logistic regression analysis, laparoscopic TMR (odds ratio [OR]; 2.114, 95% confidence interval [CI]; 1.212-3.689, p = 0.008) and postoperative ileus (OR; 2.389, 95% CI; 1.282-4.450, p = 0.006) were independent risk factors of POUR. Male gender, advanced age, neoadjuvant chemoradiation, longer operative time, abdominoperineal resection, and lateral pelvic lymph node dissection were not associated with POUR. Advanced age over 65 years also failed to show statistical significance (OR; 1.604, 95% CI; 0.965-2.668, p = 0.068).
Laparoscopic approach and postoperative ileus are risk factors for POUR after low rectal cancer surgery. We postulate that the benefits of robotic surgical systems compared to a laparoscopic approach may reduce the incidence of POUR.
术后尿潴留（POUR）的发生率和临床意义仍然很高。本研究旨在评估接受直肠系膜全切除术（TMR）治疗低位直肠癌患者的 POUR 发生率和相关危险因素。
本研究是对单中心前瞻性收集的结直肠数据库进行的回顾性研究。分析了 2006 年 9 月至 2017 年 5 月期间因低位直肠癌接受手术治疗的患者的数据，以评估 POUR 的危险因素。POUR 被定义为拔除导尿管后无法排尿，需要重新插入导尿管，以及排空膀胱困难，需要间歇性导尿。
在 555 例低位直肠癌患者中，78 例（14.1%）发生了 POUR。基于多变量逻辑回归分析，腹腔镜 TMR（比值比 [OR]；2.114，95%置信区间 [CI]；1.212-3.689，p = 0.008）和术后肠梗阻（OR；2.389，95%CI；1.282-4.450，p = 0.006）是 POUR 的独立危险因素。男性、高龄、新辅助放化疗、手术时间较长、腹会阴联合切除术和侧方盆腔淋巴结清扫术与 POUR 无关。年龄超过 65 岁也没有统计学意义（OR；1.604，95%CI；0.965-2.668，p = 0.068）。
腹腔镜入路和术后肠梗阻是低位直肠癌手术后 POUR 的危险因素。我们推测，与腹腔镜入路相比，机器人手术系统的优势可能会降低 POUR 的发生率。
