Laparoscopic Colonic Resection Without Urinary Drainage: Is It "Feasible"?

Area of Science:

• Colorectal Surgery
• Enhanced Recovery Pathways
• Urology

Background:

• Urinary retention (UR) and urinary tract infection (UTI) are common, costly complications after colorectal surgery.
• Optimizing patient recovery after colon resection is a priority, but optimal urinary catheterization (UC) strategies remain debated.

Purpose of the Study:

• To evaluate the safety and feasibility of a "fast track" protocol that avoids routine urinary catheterization (UC) in patients undergoing elective segmental colon resection.
• To assess the impact of this protocol on rates of urinary retention (UR) and urinary tract infection (UTI).

Main Methods:

• Prospective enrollment of patients undergoing elective segmental colon resection.
• Implementation of a "fast track" protocol where UC was avoided unless medically necessary.
• Systematic recording of patient demographics, perioperative data, and outcomes including UR and UTI rates.

Main Results:

• Out of 65 patients, 33.8% required temporary UC; all patients left the OR without a catheter.
• Urinary retention (UR) occurred in 9.2% of patients, with no significant difference between those with or without epidural analgesia.
• A single UTI (1.5%) was observed in a patient not requiring UC; no perioperative mortality occurred.

Conclusions:

• A "fast track" enhanced recovery protocol for elective segmental colon resection is safe and feasible without routine UC.
• Epidural analgesia does not necessitate UC in this patient population.
• Avoiding UC merits further investigation due to the significant morbidity and cost associated with UR and UTI.