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Early Urinary Catheter Removal Following Pelvic Colorectal Surgery

A Prospective, Randomized, Noninferiority Trial

Patel, Devin N., M.D.; Felder, Seth I., M.D.; Luu, Michael, M.P.H.; Daskivich, Timothy J., M.D.; N. Zaghiyan, Karen, M.D.; Fleshner, Phillip, M.D.

doi: 10.1097/DCR.0000000000001206
Original Contributions: Benign
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BACKGROUND: Because of the potential increased incidence of acute urinary retention, optimal timing of urinary catheter removal after major pelvic colorectal surgery remains unclear.

OBJECTIVE: This study aims to compare the incidence of urinary retention following early catheter removal on postoperative day 1 vs standard catheter removal on day 3.

DESIGN: This is a randomized, noninferiority trial.

SETTING: This study was conducted at an urban teaching hospital.

PATIENTS: Patients undergoing colorectal surgery below the peritoneal reflection were selected.

INTERVENTIONS: A 1:1 randomization to early or standard catheter removal was performed. Patients in the early arm were administered an α-antagonist (prazosin 1 mg oral) 6 hours before catheter removal.

MAIN OUTCOME MEASURES: The primary outcome measured was the incidence of acute urinary retention.

RESULTS: One hundred forty-two patients were randomly assigned to early (n = 71) or standard (n = 71) catheter removal. Mean age was 44.8 ± 16.9 years, and the study cohort included 54% men. The most common operations were IPAA (66%) and low anterior resection (18%). The overall rate of retention was 9.2% (n = 13), with no difference between early (n = 6; 8.5%) or standard (n = 7; 9.9%) catheter removal (RR, 0.86; 95% CI, 0.30–2.42). The risk difference was –1.4% (95% CI, –8.3 to 11.1), confirming noninferiority. The rate of infection was significantly lower in early vs standard catheter removal (0% vs 11.3%; p = 0.01). Length of stay was significantly shorter after early vs standard catheter removal (4 days, interquartile range = 3–6 vs 5 days, interquartile range = 4–7; p = 0.03).

LIMITATIONS: Patients and investigators were not blinded; a nonselective oral α-antagonist was used.

CONCLUSIONS: Following pelvic colorectal surgery, early urinary catheter removal, when combined with the addition of an oral α-antagonist, is noninferior to standard urinary catheter removal and carries a lower risk of symptomatic infection and shorter hospital stay. Clinical Trial Registration: http://www.clinicaltrials.gov (NCT01923129). See Video Abstract at http://links.lww.com/DCR/A738.

Divisions of Colorectal Surgery and Urology, Cedars-Sinai Medical Center, Los Angeles, California

Funding/Support: None reported.

Financial Disclosures: None reported.

Podium presentation at the meeting of the American Society of Colon and Rectal Surgeons, Nashville, TN, May 19 to 23, 2018.

Correspondence: Devin N. Patel, M.D., Cedars-Sinai Medical Center, 8635 West 3rd St, Ste 1070W, Los Angeles, CA 90048. E-mail: devin.patel@cshs.org

© 2018 The American Society of Colon and Rectal Surgeons