The value of routine preoperative urological assessment in patients undergoing elective surgery for diverticular disease or carcinoma of the large bowel.

Abstract

A consecutive series of 176 patients was studied prospectively in order to assess the value of full urological assessment prior to elective colorectal surgery for carcinoma or diverticular disease. Fifty-one patients had urological symptoms and 29 of these had an abnormal intravenous urogram (IVU); when compared with the 125 asymptomatic patients, they were twice as likely to develop acute retention of urine and four times more likely to require prostatectomy. Twenty of the 31 patients with an abdominal mass had an abnormal intravenous urogram, and the presence of this physical sign may be regarded as an absolute indication for IVU. Forty-five patients had a urological abnormality on the preoperative IVU; of these, 1 in 6 required treatment prior to elective large bowel surgery and 1 in 3 developed acute retention of urine postoperatively (half required prostatectomy). Twenty-two patients had a disease-related abnormality on preoperative IVU and in 12 planned urological surgery was undertaken at the time of the colorectal resection. In the 91 patients with no urological symptoms, no abnormal mass and normal blood urea and mid-stream urine sample, the incidence of IVU abnormalities and of postoperative complications was low and surgical management was not altered in these patients.