BACKGROUND: Because of the potential increased incidence of acute urinary retention, optimal timing of urinary catheter removal after major pelvic colorectal surgery remains unclear. OBJECTIVE: This study aims to compare the incidence of urinary retention following early catheter removal on postoperative day 1 vs standard catheter removal on day 3. DESIGN: This is a randomized, noninferiority trial. SETTING: This study was conducted at an urban teaching hospital. PATIENTS: Patients undergoing colorectal surgery below the peritoneal reflection were selected. INTERVENTIONS: A 1:1 randomization to early or standard catheter removal was performed. Patients in the early arm were administered an α-antagonist (prazosin 1 mg oral) 6 hours before catheter removal. MAIN OUTCOME MEASURES: The primary outcome measured was the incidence of acute urinary retention. RESULTS:One hundred forty-two patients were randomly assigned to early (n = 71) or standard (n = 71) catheter removal. Mean age was 44.8 ± 16.9 years, and the study cohort included 54% men. The most common operations were IPAA (66%) and low anterior resection (18%). The overall rate of retention was 9.2% (n = 13), with no difference between early (n = 6; 8.5%) or standard (n = 7; 9.9%) catheter removal (RR, 0.86; 95% CI, 0.30-2.42). The risk difference was -1.4% (95% CI, -8.3 to 11.1), confirming noninferiority. The rate of infection was significantly lower in early vs standard catheter removal (0% vs 11.3%; p = 0.01). Length of stay was significantly shorter after early vs standard catheter removal (4 days, interquartile range = 3-6 vs 5 days, interquartile range = 4-7; p = 0.03). LIMITATIONS: Patients and investigators were not blinded; a nonselective oral α-antagonist was used. CONCLUSIONS: Following pelvic colorectal surgery, early urinary catheter removal, when combined with the addition of an oral α-antagonist, is noninferior to standard urinary catheter removal and carries a lower risk of symptomatic infection and shorter hospital stay. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov (NCT01923129). See Video Abstract at http://links.lww.com/DCR/A738.
RCT Entities:
BACKGROUND: Because of the potential increased incidence of acute urinary retention, optimal timing of urinary catheter removal after major pelvic colorectal surgery remains unclear. OBJECTIVE: This study aims to compare the incidence of urinary retention following early catheter removal on postoperative day 1 vs standard catheter removal on day 3. DESIGN: This is a randomized, noninferiority trial. SETTING: This study was conducted at an urban teaching hospital. PATIENTS: Patients undergoing colorectal surgery below the peritoneal reflection were selected. INTERVENTIONS: A 1:1 randomization to early or standard catheter removal was performed. Patients in the early arm were administered an α-antagonist (prazosin 1 mg oral) 6 hours before catheter removal. MAIN OUTCOME MEASURES: The primary outcome measured was the incidence of acute urinary retention. RESULTS: One hundred forty-two patients were randomly assigned to early (n = 71) or standard (n = 71) catheter removal. Mean age was 44.8 ± 16.9 years, and the study cohort included 54% men. The most common operations were IPAA (66%) and low anterior resection (18%). The overall rate of retention was 9.2% (n = 13), with no difference between early (n = 6; 8.5%) or standard (n = 7; 9.9%) catheter removal (RR, 0.86; 95% CI, 0.30-2.42). The risk difference was -1.4% (95% CI, -8.3 to 11.1), confirming noninferiority. The rate of infection was significantly lower in early vs standard catheter removal (0% vs 11.3%; p = 0.01). Length of stay was significantly shorter after early vs standard catheter removal (4 days, interquartile range = 3-6 vs 5 days, interquartile range = 4-7; p = 0.03). LIMITATIONS: Patients and investigators were not blinded; a nonselective oral α-antagonist was used. CONCLUSIONS: Following pelvic colorectal surgery, early urinary catheter removal, when combined with the addition of an oral α-antagonist, is noninferior to standard urinary catheter removal and carries a lower risk of symptomatic infection and shorter hospital stay. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov (NCT01923129). See Video Abstract at http://links.lww.com/DCR/A738.
Authors: Yung Lee; Tyler McKechnie; Jeremy E Springer; Aristithes G Doumouras; Dennis Hong; Cagla Eskicioglu Journal: Int J Colorectal Dis Date: 2019-11-09 Impact factor: 2.571