Laparoscopic elective colonic resections in ERAS patients without the use of urinary catheterization

Abstract

Objectives: Urinary catheterization (UC) is used in colorectal surgery to monitor urinary output, decompress the bladder and avoid urinary retention (UR). In recent years several studies have showed a decreased rate of UTI with early removal of urinary catheters. When implementing the ERAS protocol Østfold Hospital decided to discontinue its practice of UC as a part of standard preoperative care amongst patients who had an expected surgery time of less than two hours. We investigated the incidence of postoperative UR and how UR was handled amongst said patients. Methods: We retrospectively enrolled all ERAS patients undergoing elective colonic resection from April 2017 through December 2017 with expected surgery time <2 hours. Patients who received an UC preoperatively were excluded. UR was defined as postoperative bladder residual volume of >400mL or inability to void urine with bladder discomfort. All patients who did not have spontaneous urination at the postoperative department underwent ultrasonographic bladder scan. Patient demographics, rate of postoperative UR and rate and timing of peri- and postoperative UC were examined. X2 test was used to determine significant correlation between patient demographics and incidence of UR. Results: 54 patients were included. Laparoscopic right hemicolectomy was the most common procedure (81,4%). Postoperative UR occurred in 11 patients (20,3%). One patient received an UC peroperatively due to iatrogenic bladder injury. 6 patients with UR underwent single-procedure UC and had spontaneous urination after this. 4 patients experienced more than 1 episode of UR and received a permanent catheter. 1 patient immediately received a permanent catheter. There was no statistical significance between gender (p = 0,639) or age (p = 0,452) and incidence of UR. Overall 43 patients (79,6%) successfully underwent colonic segmental resection without the need of UC during their hospitalization. Conclusion: We suggest that laparoscopic segmental colonic resections with expected surgical time less than two hours can be performed without urinary catheterization. Further studies are needed to investigate the group of patients who experienced UR to aid in selection of patients for UC and avoid UR as a complication. Disclosure of Interest: None declared.