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

Abstract

Because of the potential increased incidence of acute urinary retention, optimal timing of urinary catheter removal after major pelvic colorectal surgery remains unclear. 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. This is a randomized, noninferiority trial. This study was conducted at an urban teaching hospital. Patients undergoing colorectal surgery below the peritoneal reflection were selected. 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. The primary outcome measured was the incidence of acute urinary retention. 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). Patients and investigators were not blinded; a nonselective oral α-antagonist was used. 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. http://www.clinicaltrials.gov (NCT01923129). See Video Abstract at http://links.lww.com/DCR/A738.