title: Early post-operative removal of urethral catheter in patients undergoing colorectal surgery with epidural analgesia – a prospective pilot clinical study.
abstract: BACKGROUND
  Urethral catheter (UC) removal is often delayed following colorectal resection due to the perceived increased risk of post-operative urinary retention (POUR) in patients with post-operative epidural analgesia (POEA). We aimed to determine if UC removal at 48 h, irrespective of ongoing POEA use, altered the risk of POUR and other morbidities associated with urethral catheterisation and immobility.
  
  
  METHODS
  We performed a prospective randomised controlled pilot clinical study. Eligible patients were randomised to an experimental arm, SG1 (UC removal 48 h post-operatively), or a control arm, SG2 (UC removed following cessation of POEA). Rates of POUR, urinary tract infection (UTI), pulmonary complications and surgical site infection (SSI) were recorded. Forty-four patients were recruited (SG1: n = 22; SG2: n = 22).
  
  
  RESULTS
  No females developed POUR, while it occurred in three males (20%) in SG1 and 2 males (22.2%) in SG2. All patients who developed POUR had undergone rectal resection. Males in SG1 were not at significantly increased risk of POUR compared to those in SG2 (R.R 0.875, p = 1). No patient developed UTI post-operatively. The rate of pulmonary complications (SG1: n = 2; SG2: n = 3, p = 0.229) and SSI (SG1: n = 5; SG2: n = 2, p = 0.146) were similar between both study arms.
  
  
  CONCLUSIONS
  Males undergoing rectal surgery appear to be at increased risk of developing POUR in the presence of epidural analgesia, independent of the timing of UC removal.
  
  
  CONCLUSIONS
  All female patients undergoing colorectal resection and male patients undergoing colonic resection may have their urethral catheter removed at 48 h irrespective of use of POEA.
  
  
  BACKGROUND
  NCT01508767 (http://www.clinicaltrials.gov).
authors.affiliation: Department of Surgery, University Hospital Galway, Newcastle, Galway, Ireland. Electronic address: david.coyle@ucd.ie.
authors.forename: David
authors.initials: D
authors.lastname: Coyle
authors.affiliation: Department of Surgery, University Hospital Galway, Newcastle, Galway, Ireland.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Joyce
authors.affiliation: Department of Surgery, University Hospital Galway, Newcastle, Galway, Ireland.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Garvin
authors.affiliation: Department of Surgery, University Hospital Galway, Newcastle, Galway, Ireland.
authors.forename: Mark
authors.initials: M
authors.lastname: Regan
authors.affiliation: Department of Surgery, University Hospital Galway, Newcastle, Galway, Ireland.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: McAnena
authors.affiliation: Department of Surgery, University Hospital Galway, Newcastle, Galway, Ireland.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Neary
authors.affiliation: Department of Surgery, University Hospital Galway, Newcastle, Galway, Ireland.
authors.forename: Myles R
authors.initials: MR
authors.lastname: Joyce
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D003106:Colon / Q000601:surgery*; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects*; D016055:Urinary Retention / Q000209:etiology*; D014552:Urinary Tract Infections / Q000209:etiology*
keywords: Colectomy; Colorectal; Detrusor; Epidural analgesia; Post-operative urinary retention; Urinary catheter