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. 2016 Mar;31(3):511-8.
doi: 10.1007/s00384-015-2471-8. Epub 2015 Dec 22.

Management of postoperative bladder emptying after proctectomy in men for rectal cancer. A retrospective study of 190 consecutive patients

Cécile Bouchet-Doumenq  1 , Jérémie H Lefevre  2 , Malika Bennis  1 , Najim Chafai  1 , Emmanuel Tiret  1 , Yann Parc  1
Affiliations

Management of postoperative bladder emptying after proctectomy in men for rectal cancer. A retrospective study of 190 consecutive patients

Cécile Bouchet-Doumenq et al. Int J Colorectal Dis. 2016 Mar.

Abstract

Purpose: Evaluation of urinary drainage after rectal resection and identification of criteria associated with postoperative urinary dysfunction (UD). UD remains a clinical problem for up to two thirds of patients after rectal resection. Currently, there are no guidelines concerning duration or type of drainage.

Methods: One hundred ninety consecutive rectal resections (abdomino-perineal resection (APR = 47), mechanical coloanal anastomosis (MechCAA = 48), manual coloanal anastomosis (ManCAA = 47), colorectal anastomosis (CRA = 48)) in male patients were included. In patients with a transurethral catheterization (TUC), the drainage was removed at day 5. Patients with a suprapubic catheterization (SPC) underwent drainage removal according to the results of a clamping test at day 5. UD was defined as drainage removal after day 6 and/or acute urinary retention (AUR).

Results: Drainage types were SPC (n = 136, 72%) and TUC (n = 54, 28%). SPC was used more frequently after total mesorectal excision (TME) (APR, ManCAA, MechCAA) (83-92%). Complications rates of SPC and TUC were 20 and 9%. The clamping test was positive for 61 patients (48%), and SPC was removed before/on POD6 without any episode of AUR. After TUC removal, two patients (4%) had AUR. Seventy-two (38%) patients had UD: 11 (6%) were discharged with an indwelling catheter, and in 61 (32%), the catheter was removed after day6. Three independent factors were associated with UD: diabetes (OR = 2.9 (1.2-7.7)), urological history (OR = 2.9 (1.2-7.6)), and TME (OR = 5.2 (2.3-13.5)).

Conclusion: The UD rate after surgery for rectal cancer was 38%. The clamping test is accurate to prevent AUR after SPC removal. The three risk factors may serve to select good candidates for early catheter removal.

Keywords: Colorectal anastomosis; Rectal cancer; Suprapubic catheterization; Transurethral catheterization; Urinary dysfunction.

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