Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
Int J Colorectal Dis. 2023 Jun 7;38(1):162. doi: 10.1007/s00384-023-04460-3.
The Enhanced Recovery After Surgery protocol for colorectal surgery recommends early urinary catheter (UC) removal after surgery. However, the optimal timing remains controversial. We aimed to evaluate the safety of immediate UC removal and risk factors of postoperative urinary retention (POUR) after colorectal cancer surgery.
From November 2019 and April 2022, patients who underwent elective colorectal cancer surgery at Seoul St. Mary's hospital were collected retrospectively. A UC was inserted in the operating room after general anesthesia and removed in the operating room immediately after surgery. The primary outcome was the occurrence of POUR following immediate UC removal after surgery, and the secondary outcomes were the identification of POUR-related risk factors and postoperative complications.
Among 737 patients, 81 (10%) had POUR immediately after UC removal. No patient had urinary tract infection. The incidence of POUR was significantly higher in male and in those with a history of urinary disease. However, there were no significant differences in tumor location, surgical procedure, or approach. The mean operative time was significantly longer in the POUR group. Postoperative morbidity and mortality rates did not differ significantly between two groups. Multivariate analysis showed that risk factors for POUR were male, a history of urinary disease, and intrathecal morphine injection.
Immediate removal of UC immediately after colorectal surgery is safe and feasible in the trend of ERAS. Male, a history of benign prostatic hyperplasia, and intrathecal morphine injection were risk factors for POUR.
结直肠手术的加速康复外科（ERAS）方案建议术后尽早拔除导尿管（UC）。然而，最佳时机仍存在争议。本研究旨在评估结直肠癌手术后即刻拔除 UC 的安全性，并确定术后尿潴留（POUR）的危险因素。
本研究回顾性收集了 2019 年 11 月至 2022 年 4 月期间在首尔圣玛丽医院接受择期结直肠癌手术的患者。全身麻醉后在手术室插入 UC，术后即刻在手术室拔除。主要结局是术后即刻拔除 UC 后发生 POUR 的情况，次要结局是确定 POUR 的相关危险因素和术后并发症。
在 737 例患者中，81 例（10%）在 UC 拔除后立即发生 POUR。无患者发生尿路感染。男性和有尿路疾病史的患者 POUR 发生率显著更高。但肿瘤位置、手术方式或入路无显著差异。POUR 组的平均手术时间明显更长。两组术后发病率和死亡率无显著差异。多因素分析显示，POUR 的危险因素为男性、尿路疾病史和鞘内吗啡注射。
在 ERAS 的趋势下，结直肠手术后即刻拔除 UC 是安全可行的。男性、良性前列腺增生史和鞘内吗啡注射是 POUR 的危险因素。
