He Tingting, Wang Daguang, Yu Jinhai, Suo Jian, Wang Helei, Sun Donghui, Yang Jiaxin, He Liang, Zhang Luyao, Chen Yan, Sun Jianan, Wang Quan, Guo Yuchen
Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China.
Support Care Cancer. 2024 Dec 13;33(1):23. doi: 10.1007/s00520-024-09076-z.
Intermittent urethral catheter clamping is widely used to reduce secondary catheterization in patients after proctectomy; however, its effectiveness is unclear.
This study investigated the effects of intermittent catheter clamping combined with active urination training (ICCAUT) on postoperative urinary dysfunction in patients after proctectomy. This retrospective cohort study analyzed data on patients who underwent laparoscopic/robotic-assisted proctectomy at a single medical center in China between July 2023 and January 2024.
Patients received ICCAUT or free urinary drainage during the indwelling urethral catheter period after surgery. Data from the ICCAUT and free-drainage groups were compared. The primary outcome measure was urinary dysfunction. The secondary outcomes were urinary tract infections, time to first void after catheter removal, and urine volume during first voiding. Propensity-score matching (PSM), inverse probability-of-treatment weighting (IPTW), and multivariable logistic regression analyses were used to identify factors associated with urinary dysfunction.
Among 360 eligible patients, 173 received a free-drainage strategy and 187 received ICCAUT. The incidence of urinary dysfunction was 52.5% overall and was significantly lower in the ICCAUT group than in the free-drainage group (45.1% vs. 59.4%; p = 0.009). The lower incidence of urinary dysfunction in the ICCAUT group was confirmed in the PSM (44.7% vs. 59.3%; p = 0.03) and IPTW (44.5% vs. 57.1%; p = 0.028) analyses. Multivariable logistic regression analysis revealed that ICCAUT was independently associated with a lower risk of urinary dysfunction (OR, 0.55; 95% CI, 0.34-0.89; p = 0.015). Subgroup analysis found that, compared with female patients, male patients are more likely to benefit from the ICCAUT strategy (p for interaction = 0.029; adjusted OR, 0.33; 95% CI, 0.17-0.62; p < 0.001). The ICCAUT strategy did not significantly increase the risk of urinary tract infection (p = 0.349).
The ICCAUT strategy may benefit the recovery of urinary function after proctectomy, especially for male patients. ICCAUT showed an independent association with a lower risk of urinary dysfunction and UTI, with urinary tract infection comparable to that of the free-drainage strategy.
间歇性尿道导管夹闭术广泛应用于直肠切除术后患者以减少二次导尿，但该方法的有效性尚不清楚。
本研究调查了间歇性导管夹闭联合主动排尿训练（ICCAUT）对直肠切除术后患者术后排尿功能障碍的影响。这项回顾性队列研究分析了2023年7月至2024年1月在中国某单一医疗中心接受腹腔镜/机器人辅助直肠切除术患者的数据。
患者在术后留置尿道导管期间接受ICCAUT或自由尿液引流。比较ICCAUT组和自由引流组的数据。主要结局指标是排尿功能障碍。次要结局指标是尿路感染、拔除导管后首次排尿时间以及首次排尿时的尿量。采用倾向评分匹配（PSM）、逆概率处理加权（IPTW）和多变量逻辑回归分析来确定与排尿功能障碍相关的因素。
在360例符合条件的患者中，173例采用自由引流策略，187例采用ICCAUT。总体排尿功能障碍发生率为52.5%，ICCAUT组显著低于自由引流组（45.1%对59.4%；p = 0.009）。PSM分析（44.7%对59.3%；p = 0.03）和IPTW分析（44.5%对57.1%；p = 0.028）均证实ICCAUT组排尿功能障碍发生率较低。多变量逻辑回归分析显示，ICCAUT与较低的排尿功能障碍风险独立相关（OR，０.55；95%CI，0.34 - 0.89；p = 0.015）。亚组分析发现，与女性患者相比，男性患者更可能从ICCAUT策略中获益（交互作用p = 0.029；调整后OR，0.33；95%CI，0.17 - 0.62；p < 0.001）。ICCAUT策略未显著增加尿路感染风险（p = 0.349）。
ICCAUT策略可能有利于直肠切除术后排尿功能的恢复尤其对男性患者。ICCAUT与较低的排尿功能障碍和尿路感染风险独立相关，尿路感染情况与自由引流策略相当。
