Cécile Bouchet-Doumenq1, Jérémie H Lefevre2, Malika Bennis1, Najim Chafai1, Emmanuel Tiret1, Yann Parc1. 1. Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. 2. Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. jeremie.lefevre@aphp.fr.
Abstract
PURPOSE: Evaluation of urinary drainage after rectal resection and identification of criteria associated with postoperative urinary dysfunction (UD). UD remains a clinical problem for up to two thirds of patients after rectal resection. Currently, there are no guidelines concerning duration or type of drainage. METHODS: One hundred ninety consecutive rectal resections (abdomino-perineal resection (APR = 47), mechanical coloanal anastomosis (MechCAA = 48), manual coloanal anastomosis (ManCAA = 47), colorectal anastomosis (CRA = 48)) in male patients were included. In patients with a transurethral catheterization (TUC), the drainage was removed at day 5. Patients with a suprapubic catheterization (SPC) underwent drainage removal according to the results of a clamping test at day 5. UD was defined as drainage removal after day 6 and/or acute urinary retention (AUR). RESULTS: Drainage types were SPC (n = 136, 72%) and TUC (n = 54, 28%). SPC was used more frequently after total mesorectal excision (TME) (APR, ManCAA, MechCAA) (83-92%). Complications rates of SPC and TUC were 20 and 9%. The clamping test was positive for 61 patients (48%), and SPC was removed before/on POD6 without any episode of AUR. After TUC removal, two patients (4%) had AUR. Seventy-two (38%) patients had UD: 11 (6%) were discharged with an indwelling catheter, and in 61 (32%), the catheter was removed after day6. Three independent factors were associated with UD: diabetes (OR = 2.9 (1.2-7.7)), urological history (OR = 2.9 (1.2-7.6)), and TME (OR = 5.2 (2.3-13.5)). CONCLUSION: The UD rate after surgery for rectal cancer was 38%. The clamping test is accurate to prevent AUR after SPC removal. The three risk factors may serve to select good candidates for early catheter removal.
PURPOSE: Evaluation of urinary drainage after rectal resection and identification of criteria associated with postoperative urinary dysfunction (UD). UD remains a clinical problem for up to two thirds of patients after rectal resection. Currently, there are no guidelines concerning duration or type of drainage. METHODS: One hundred ninety consecutive rectal resections (abdomino-perineal resection (APR = 47), mechanical coloanal anastomosis (MechCAA = 48), manual coloanal anastomosis (ManCAA = 47), colorectal anastomosis (CRA = 48)) in male patients were included. In patients with a transurethral catheterization (TUC), the drainage was removed at day 5. Patients with a suprapubic catheterization (SPC) underwent drainage removal according to the results of a clamping test at day 5. UD was defined as drainage removal after day 6 and/or acute urinary retention (AUR). RESULTS: Drainage types were SPC (n = 136, 72%) and TUC (n = 54, 28%). SPC was used more frequently after total mesorectal excision (TME) (APR, ManCAA, MechCAA) (83-92%). Complications rates of SPC and TUC were 20 and 9%. The clamping test was positive for 61 patients (48%), and SPC was removed before/on POD6 without any episode of AUR. After TUC removal, two patients (4%) had AUR. Seventy-two (38%) patients had UD: 11 (6%) were discharged with an indwelling catheter, and in 61 (32%), the catheter was removed after day6. Three independent factors were associated with UD: diabetes (OR = 2.9 (1.2-7.7)), urological history (OR = 2.9 (1.2-7.6)), and TME (OR = 5.2 (2.3-13.5)). CONCLUSION: The UD rate after surgery for rectal cancer was 38%. The clamping test is accurate to prevent AUR after SPC removal. The three risk factors may serve to select good candidates for early catheter removal.
Authors: Sung Han Kim; Boram Park; Whi-An Kwon; Jae Young Joung; Ho Kyung Seo; Jinsoo Chung; Kang Hyun Lee Journal: Biomed Res Int Date: 2019-03-31 Impact factor: 3.411