Optimal timing of urinary catheter removal following pelvic colorectal surgery: a systematic review and meta-analysis
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Acute urinary retention (AUR) is a common postoperative complication in colorectal surgery. In pelvic colorectal operations, the optimal duration for postoperative urinary catheter use is controversial. This systematic review and meta-analysis aims to compare early (POD 1), intermediate (POD 3), and late (POD 5) urinary catheter removal.
Medline, EMBASE, CENTRAL, and PubMed databases were searched. Articles were eligible for inclusion if they compared patients with urinary catheter removal on POD 1 or earlier to patients with urinary catheter removal on POD 2 or later in major pelvic colorectal surgeries. The primary outcome was rate of postoperative AUR. The secondary outcome was rates of postoperative urinary tract infection (UTI).
From 691 relevant citations, five studies with 928 patients were included. Comparison of urinary catheter removal on POD 1 versus POD 3 demonstrated no significant difference in rate of urinary retention (RR 1.36, 95%CI 0.83–2.21, P = 0.22); however, compared to POD 5, rates of AUR were significantly higher (RR 2.58, 95%CI 1.51–4.40, P = 0.0005). Rates of UTI were not significantly different between POD 1 and POD 3 urinary catheter removal (RR 0.40, 95%CI 0.05–3.71, P = 0.45), but removal on POD 5 significantly increased risk of UTI compared to POD 1 (RR 0.50, 95%CI 0.31–0.81, P = 0.005).
Risk of AUR can be minimized with late postoperative urinary catheter removal compared to early removal, but at the cost of increased risk of UTI. Patient-specific factors should be taken into consideration when deciding upon optimal duration of postoperative urinary catheterization.
KeywordsColorectal surgery Pelvic surgery Urinary catheter Acute urinary retention Urinary tract infections
Study concept and design–E, H, M, L.
Acquisition of data–M, L.
Analysis and interpretation of data–all authors.
Drafting of manuscript–D, S, M, L.
Critical revision of the manuscript for intellectual content–all authors.
Final approval of version to be published–all authors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interests.
- 2.Slors FJ, van Zuijlen PP, van Dijk GJ (2000) Sexual and bladder dysfunction after total mesorectal excision for benign diseases. Scand J Gastroenterol Suppl (232):48–51Google Scholar
- 3.Kang S-B, Park JW, Jeong S-Y, Nam BH, Choi HS, Kim D-W, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645CrossRefGoogle Scholar
- 4.Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Feldman LS, Steele SR (2017) Clinical practice guidelines for enhanced recovery after Colon and Rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 60:761–784CrossRefGoogle Scholar
- 18.Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Mills S et al Risk factors for postoperative urinary tract infection and urinary retention in patients undergoing surgery for colorectal CancerGoogle Scholar
- 20.Zelmanovich A, Fromer DL (2018) Urinary retention after orthopedic surgery: identification of risk factors and management. J Clin Exp Orthop 04(01)Google Scholar
- 25.Meddings J, Skolarus TA, Fowler KE, Bernstein SJ, Dimick JB, Mann JD, Saint S (2019) Michigan appropriate perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA appropriateness method. BMJ Qual Saf 28(1):56–66CrossRefGoogle Scholar