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Early Urinary Catheter Removal Following Pelvic Colorectal Surgery: A Prospective, Randomized, Noninferiority Trial

Devin N Patel¹, Seth I Felder, Michael Luu

¹Divisions of Colorectal Surgery and Urology, Cedars-Sinai Medical Center, Los Angeles, California.

Diseases of the Colon and Rectum

|September 8, 2018

Insights

Early urinary catheter removal after pelvic colorectal surgery, combined with an oral α-antagonist, is as effective as standard removal. This approach reduces infection rates and hospital stays.

Area of Science:

Urology
Colorectal Surgery
Clinical Trials

Background:

Optimal timing for urinary catheter removal post-pelvic colorectal surgery is unclear due to potential acute urinary retention.
Early removal may reduce risks, but requires further investigation.

Purpose of the Study:

To compare the incidence of acute urinary retention after early (postoperative day 1) versus standard (postoperative day 3) urinary catheter removal.
To assess the safety and efficacy of early catheter removal in patients undergoing major pelvic colorectal surgery.

Main Methods:

A randomized, noninferiority trial involving 142 patients undergoing pelvic colorectal surgery.
Patients were randomized 1:1 to early catheter removal (with prazosin) or standard catheter removal.
The primary outcome was the incidence of acute urinary retention.

Main Results:

No significant difference in acute urinary retention rates between early (8.5%) and standard (9.9%) removal groups (p=0.86).
Early removal group showed significantly lower infection rates (0% vs. 11.3%, p=0.01).
Early removal was associated with a shorter hospital stay (4 vs. 5 days, p=0.03).

Conclusions:

Early urinary catheter removal with an oral α-antagonist is noninferior to standard removal for preventing acute urinary retention.
This strategy lowers symptomatic infection risk and reduces hospital length of stay.
Limitations include unblinded patients and investigators, and use of a nonselective α-antagonist.

Read full analysis

Abstract

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.

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