Early removal of urinary catheters after rectal surgery is associated with increased urinary retention.
BACKGROUND
Urinary retention after rectal resection is common and managed prophylactically by prolonging urinary catheterization. However, because indwelling urinary catheterization is a well-established risk factor for urinary tract infection, the ideal timing for urinary catheter removal following a rectal resection is unknown.


OBJECTIVE
We hypothesized that early urinary catheter removal (on or before postoperative day 2) would be associated with urinary retention.


METHODS
This study is a retrospective review of medical records.


METHODS
This study was conducted at a colorectal surgery service at a tertiary care academic teaching hospital.


METHODS
Adults undergoing rectal resection operations by colorectal surgeons in 2005 to 2010 were selected.


METHODS
The primary outcome measured was urinary retention.


RESULTS
Of 205 patients included, 41 (20%) developed urinary retention. Male sex (OR, 3.9; 95% CI, 1.7-9), increased intraoperative intravenous fluid (OR for each liter, 1.2; 95% CI, 1.04-1.48), and urinary catheter removal on postoperative day 2 or earlier (OR, 3.8; 95% CI, 1.4-10.5) were associated with urinary retention on multivariable analysis. Early catheter removal was not associated with decreased urinary tract infection rates (p = 0.29) but was associated with shorter length of stay (6.5 vs 8.9 days; p = 0.005).


CONCLUSIONS
The retrospective nature of this study did not allow for a precise definition of urinary retention. Preoperative urinary function was not available, and the patient sample was heterogeneous, including several indications for rectal resection. Urinary catheters were not removed per protocol and therefore subject to bias. The study is likely underpowered to detect differences in urinary tract infection between urinary catheter removal groups.


CONCLUSIONS
In patients undergoing rectal resection, we found that urinary catheter removal on or before postoperative day 2 was associated with urinary retention (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A172).
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Mary R
MR
Kwaan
Janet T
JT
Lee
David A
DA
Rothenberger
Genevieve B
GB
Melton
Robert D
RD
Madoff
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014546:Urinary Catheterization / Q000009:adverse effects*; D062885:Urinary Catheters; D016055:Urinary Retention / Q000209:etiology*; D014552:Urinary Tract Infections / Q000209:etiology; D014554:Urination; D055815:Young Adult