Urinary retention in early Foley catheter removal after colorectal surgery. A. Ghuman, N. Kasteel, C. Brown, A. Karimuddin, M. Raval, T. Phang. From the University of British Columbia, Vancouver, B.C.

Prolonged catheterization causes increased urinary tract infections (UTIs), but early removal after surgery is linked to increased urinary retention. In our Enhanced Recovery After Surgery (ERAS) protocol for colorectal surgery, we began removal of the Foley catheter on postoperative day 2. The aim of this study is to determine the incidence of urinary retention and infection and potentially contributing factors in male patients. This was a single academic centre retrospective cohort study with male patients 50 years of age and older undergoing elective colorectal surgery from January 2015 to February 2017. Females, prior prostate surgery, tumour extension to bladder or prostate and/or intraoperative urethral or bladder injury were excluded. As of 2016, prophylactic tamsulosin 0.4mg daily was given 3 days before surgery and continued until discharge. A multivariate regression analysis was performed to determine potential risk factors for urinary retention, including age, neoadjuvant chemoradiation, history of voiding difficulty, minimally invasive surgery (MIS) versus open, lesion location, operative time American Society of Anesthesiologists (ASA) score, intraoperative fluid balance, epidural, patient-controlled analgesia (PCA), postoperative complications, including anastomotic leak and ileus, and prophylactic tamsulosin use. One hundred and eighteen patients were included in the analysis, 62 without and 56 with prophylactic tamsulosin. Urinary retention rate was 12.71% and UTI rate was 5.13%. Operative duration and ileus were found to be independent risk factors for urinary retention with adjusted odds ratios of 1.02 (95% CI 1.01-1.03, p<0.01) and 4.96 (95% CI 1.45-16.94, p<0.01) respectively. There was no significant association with age, neoadjuvant chemoradiation, history of voiding difficulty, MIS versus open, lesion location, ASA score, intraoperative fluid balance, PCA, anastomotic leak or prophylactic tamsulosin. The incidence of urinary retention and UTI at our institution is high. Urinary retention was associated with operative duration and ileus, which could potentially be explained by more difficult cases. Urinary retention was not associated with rectal lesion location or prophylactic tamrulosin. However, sample size is small and further investigation is required.

Urinary Retention In Early Foley Catheter Removal After Colorectal Surgery