Abstract
BackgroundUrinary catheters are routinely placed before colorectal surgery. Enhanced recovery after surgery (ERAS) recommends their removal as soon as possible. However, premature removal risks urinary retention, and delayed removal increases risk of urinary tract infections (UTIs). This meta-analysis aims to synthesise the published literature on the optimal timing of urinary catheter removal following colorectal surgery with pelvic dissection. Materials and methodsThe protocol for this meta-analysis is registered on PROSPERO (CRD42019150030).Pubmed, Ovid and Web of Science databases were searched (January 2020). Primary outcomes included urinary retention and catheter associated UTI. The intervention was removal of urinary catheter following colorectal surgery with pelvic dissection on postoperative days 1–2 (early); 3–4 (intermediate); or 5+ (late). Meta-analysis was performed using Comprehensive meta-analysis V2. ResultsEight papers were analysed. 883 patients had early catheter removal, 236 intermediate and 204 late. Early catheter removal was associated with increased risk of urinary retention when compared to late removal RR = 2.352 95% CI = 1.370–4.038 (p = 0.002). No significant difference in urinary retention was found between early and intermediate or intermediate and late catheter removal groups. Early catheter removal was associated with reduced risk of UTIs compared to late removal RR = 0.498, 95% CI 0.306–0.811, (p = 0.005). No significant difference in UTIs was found between early and intermediate or intermediate and late catheter removal groups. ConclusionsRemoval of urinary catheters on postoperative day 3–4 provides a balance between minimising the risks of urinary retention and UTIs. This analysis can be used to finesse future ERAS protocols concerning catheter removal in colorectal surgery involving pelvic dissection
Highlights
Pathologies involving the distal sigmoid colon, rectum and anus will often require dissection within the pelvis
One of the commonest postoperative complications following colorectal surgery with pelvic dissection is urinary retention, which can occur in up to one third of all patients ([2,3,4,5,6,7] Unsurprisingly, abdominoperineal excision of rectum (APER) and low anterior resections are associated with the highest rates of postoperative urinary retention in colorectal surgery [8]
We compared three catheter removal groups: early, intermediate and late. These groups were decided on based on Enhanced recovery after surgery (ERAS) guideline to remove catheters as early as possible and Surgical Care Improvement Project (SCIP) guideline recom mending to remove within two days postoperative
Summary
Pathologies involving the distal sigmoid colon, rectum and anus will often require dissection within the pelvis. The mechanism behind postoperative urinary retention in this setting remains unclear but may involve either injury or neuropraxia to the pelvic autonomic nerves during rectal mobilisation. Premature removal risks urinary retention, and delayed removal increases risk of urinary tract infections (UTIs) This meta-analysis aims to synthesise the published literature on the optimal timing of urinary catheter removal following colorectal surgery with pelvic dissection. The intervention was removal of urinary catheter following colorectal surgery with pelvic dissection on postoperative days 1–2 (early); 3–4 (intermediate); or 5+ (late). Catheter removal was associated with increased risk of urinary retention when compared to late removal RR = 2.352 95% CI = 1.370–4.038 (p = 0.002). This analysis can be used to finesse future ERAS protocols concerning catheter removal in colorectal surgery involving pelvic dissection
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