A prospective study of early removal of the urethral catheter after colorectal surgery in patients having epidural analgesia as part of the Enhanced Recovery After Surgery programme.

Early removal of the urethral catheters is part of the enhanced postoperative recovery programme (ERAS). The effect of epidural anaesthesia on urinary retention was investigated in patients after colorectal resection. A prospective cohort study of all patients having colorectal surgery within an ERAS programme that included insertion of an epidural catheter over the last 5 years. Two-hundred and ten patients had an epidural and a urethral catheter postoperatively. The duration of catheterization was not recorded in one patient who was therefore excluded from the study. One-hundred and eighteen patients had a trial without catheter (TWOC) prior to stopping the epidural (early TWOC). Ninety-one patients had TWOC after the epidural was stopped (late TWOC). Sixteen (7.6%) patients went into urinary retention (14 early TWOC and two late TWOC). The rate of urinary retention in the early TWOC group was significantly higher than that in the late TWOC group (11.9% vs 2.2%; χ(2), P = 0.009). Those who underwent a laparoscopic resection were significantly more likely to have undergone an early TWOC (χ(2), P = 0.001); however, there was no difference in retention rates between open and laparoscopic surgery (χ(2), P = 0.402). Pelvic surgery was not significantly associated with an increased risk of postoperative urinary retention (χ(2), P = 0.627). Male sex was not significantly associated with urinary retention (χ(2), P = 0.087). In the early TWOC group 86% had the catheter removed within 24 hours of surgery. Early TWOC with epidural analgesia running significantly increases the risk of urinary retention; however, it was still successful in 88% of patients.

Stubbs BM ，Badcock KJ ，Hyams C ，Rizal FE ，Warren S ，Francis D ... -  《-》

The management of acute urinary retention in France: a cross-sectional survey in 2618 men with benign prostatic hyperplasia.

Desgrandchamps F ，De La Taille A ，Doublet JD ，RetenFrance Study Group ... -  《-》

Early post-operative removal of urethral catheter in patients undergoing colorectal surgery with epidural analgesia – a prospective pilot clinical study.

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. 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). 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. 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. 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. NCT01508767 (http://www.clinicaltrials.gov).

Coyle D ，Joyce KM ，Garvin JT ，Regan M ，McAnena OJ ，Neary PM ，Joyce MR ... -  《-》

Optimal Timing of Removal of Epidural and Urethral Catheters to Avoid Postoperative Urinary Retention Undergoing Abdominal Surgery.

Postoperative urinary retention (POUR) is one of the most frequent complications of epidural anesthesia. This study aims to clarify risk factors of POUR and to estimate the appropriate timing of urethral catheter removal. Between September and December 2014, a retrospective cohort study was conducted on 120 patients who underwent epidural anesthesia and major abdominal surgery. To observe trends in incidence of POUR, we analyzed the order and interval of removal of epidural and urethral catheters using Cochran-Armitage trend test. In this study, 40 patients were diagnosed with POUR (33.3%). Median removal of epidural catheters was 4 postoperative days in the POUR group and 3.5 postoperative days in the non-POUR group (p = 0.04). When the urethral catheter was removed before epidural catheter, incidence of POUR was comparatively greater (p < 0.001). There were no statistical differences in surgical fields, operation approach, epidural catheter levels, or epidural opioid use. No patients had urinary tract infections. We demonstrated that removal of urethral catheter before epidural catheter contributed to increasing trends in incidence of POUR. The optimal order and interval of removal of epidural and urethral catheters should be considered to avoid POUR after abdominal surgery.

Hayami S ，Ueno M ，Kawai M ，Kuriyama T ，Kawamata T ，Yamaue H ... -  《-》

A single-center, prospective, randomized clinical trial to investigate the optimal removal time of the urinary catheter after laparoscopic anterior resection of the rectum: study protocol for a randomized controlled trial.

Xu L ，Tao ZY ，Lu JY ，Zhang GN ，Qiu HZ ，Wu B ，Lin GL ，Xu T ，Xiao Y ... -  《Trials》