Early Urinary Catheter Removal Research Articles

Implementation of early recovery after surgery (eras) protocol in chronic pancreatitis patients undergoing Frey’s procedure: a prospective study

Introduction: Enhanced recovery after surgery (ERAS) has been successfully employed in various gastrointestinal surgeries with favourable postoperative outcomes. However, pancreatic surgeons are reluctant to embrace the ERAS concept. The evidence for ERAS protocol in chronic pancreatitis (CP) patients undergoing Frey’s procedure is limited. Method: All patients who underwent Frey’s procedure for CP between April 2017 to December 2018 were included in the prospective study. Patient with a recent acute episode of pancreatitis (<4 weeks) and requiring concomitant mutivisceral resection were excluded. Twenty-two components of ERAS protocol were implemented. The prospective data were compared with patients who underwent Frey’s procedure before implementation of the ERAS protocol (January 2016 to March 2017). Result: Of the 26 patients who underwent Frey’s procedure during the study period 5 patients were excluded. Remaining patients (n=21, Group B) were compared with patients (n=23, Group A) who underwent Frey’s procedure before implementation of ERAS protocol. The compliance was 100% for all ERAS components except for the avoidance of postoperative opioids. More number of patients in Group A received intraoperative opioids than group B (p=0.01). Group B patient had early drain removal (4.07 Vs 1.07 days, p=0.00) early urinary catheter removal (2.4 Vs 1.53 days, p=0.002), early bowel movement (mean= 2.4 days, p=0.002) and tolerated oral semisolid diet earlier (mean=3.4 days, p=0.039) than Group A patients. Postoperative complications (p=0.234), duration of ICU stay (p=1), postoperative hospital stay (p=0.241) and readmission rate were comparable between both groups. Conclusion: Implementation of ERAS protocol in CP patients undergoing Frey’ procedure is feasible and safe. ERAS protocol reduced intraoperative opioids requirements with early recovery of bowel movement and tolerance to semisolid diet. However, compliance for the avoidance of postoperative opioids was poor.

Outcomes of Early Removal of Urinary Catheter Following Rectal Resection for Cancer.

Early postoperative urinary catheter removal decreases urinary tract infection (UTI) rate and accelerates patient mobilization. The aim of this study is to determine the results of systematic urinary catheter removal on postoperative day (POD) 1 in patients undergoing rectal resection for cancer. Using a prospectively maintained database of 469 patients who underwent rectal resection for cancer, a retrospective review of all patients with urinary catheter removal on POD1 was conducted. Patients unable to void 6h after catheter removal underwent in and out urinary catheterization (IOC group) and were compared with patients who voided spontaneously (non-IOC group) to determine risk factors for IOC. A total of 417 patients were identified, including 274 (66%) men. Median age was 59 (50-68) years. Abdominoperineal resection (APR) was performed in 134 (32%), and complex surgery with resection of at least one other organ in 72 (17%) patients. Non-IOC and IOC groups included 245 (59%) and 172 (41%) patients, respectively. Five independent predictive factors for IOC were male gender, obesity, history of obstructive urinary disease, APR, and metastatic disease. The cumulative risk of IOC in patients with zero, one, two, and at least three risk factors was 8%, 31%, 52%, and 68% on POD1, and 2%, 12%, 23%, and 30% on POD5, respectively (p < 0.001). Thirteen patients (3%) developed UTI. Early removal of urinary catheter resulted in 59% of patients voiding spontaneously with no need for IOC following rectal resection. Patients without any predictive factors had less than 10% risk of urinary dysfunction.

Implementation of an enhanced recovery after surgery (ERAS) program following hepato- pancreato-biliary (HPB) surgeries – Our experience

Introduction: Enhanced recovery after surgery (ERAS) program is an evidence based multimodal perioperative framework developed to reduce postoperative stress and accelerate recovery. Pancreatic and hepatobiliary surgery being highly complex procedures, our study aims in evaluating the role of ERAS protocol in these surgeries. Methodology: It is a prospective case study where ERAS protocol has been applied in patients undergoing pancreatic (n = 33) and hepatobiliary (n = 28) surgeries and results were compared with similar established studies. Results: Demographics, preoperative and operative variables have been assessed in both the groups and were compared with similar studies where no significant difference was noted. In pancreatic surgeries, the mean POPH ( postoperative hospital stay) was 8.7 days, only 2 patients had been re-operated and 9 had readmission. Pancreatic fistula was noted in 9 patients while no patients presented with biliary fistula. In hepatobiliary surgeries, the mean POPH was 7.68 days, only 5 patients had readmission. Complications like bile leak and liver failure are noted in only 2 patients. In both the groups there is decrease in flatus time, early removal of surgical drains, nasogastric tube and urinary catheter, early mobilisation and introduction of oral/ feeding jejunostomy feeds. The results were comparable. Discussion: Following ERAS protocols, the length of postoperative stay can be reduced significantly with consistent decrease in readmission and reoperation rates not compromising patient safety together with acceleration in gastrointestinal function in HPB surgeries. Conclusion: The ERAS program implemented in our study was found to be safe and feasible in HPB surgeries in reducing POPH.

Early versus delayed removal of indwelling catheters in patients after elective cesarean section: a prospective randomized trial

Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12 h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time.Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2 h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12 h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time.Results: Urinary frequency (p = .04), microscopic hematuria incidence (p = .04), postoperative mobilization time (p = .01), and length of hospital stay (p = .009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time.Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.

Implementation of a Nurse-Driven Protocol for Catheter Removal to Decrease Catheter-Associated Urinary Tract Infection Rate in a Surgical Trauma ICU.

Early removal of urinary catheters is an effective strategy for catheter-associated urinary tract infection (CAUTI) prevention. We hypothesized that a nurse-directed catheter removal protocol would result in decreased catheter utilization and CAUTI rates in a surgical trauma intensive care unit (STICU). We performed a retrospective, cohort study following implementation of a multimodal CAUTI prevention bundle in the STICU of a large tertiary care center. Data from a 19-month historical control were compared to data from a 15-month intervention period. Pre- and postintervention indwelling catheter utilization and CAUTI rates were compared. Catheter utilization decreased significantly with implementation of the nurse-driven protocol from 0.78 in the preintervention period to 0.70 in the postintervention period (P < .05). As a result of the bundle, the CAUTI rate declined significantly, from 5.1 to 2.0 infections per 1000 catheter-days in the pre- vs postimplementation period (Incident Rate Ratio [IRR]: 0.38, 95% confidence interval: 0.21-0.65). Implementation of a nurse-driven protocol for early urinary catheter removal as part of a multimodal CAUTI intervention strategy can result in measurable decreases in both catheter utilization and CAUTI rates.

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

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.

Identification of core items in the enhanced recovery pathway

The Enhanced Recovery After Surgery (ERAS) pathway represents an optimal approach in patients undergoing colorectal surgery but complexity in implementing its items could limit its application. The aim of this study is to identify possible core items within an ERAS pathway following elective colorectal resection. This is a retrospective review of data prospectively collected between January 2014 and September 2015 by 14 Italian Hospitals in an electronic registry dedicated to an ERAS protocol. 722 patients undergoing elective colorectal surgery within an ERAS protocol have been included in the study. Adherence to ERAS items was assessed in all patients. A secondary analysis was restricted to pre- and intraoperative ERAS items. Time to readiness for discharge (TRD) was the primary endpoint of the study. Postoperative overall morbidity was the secondary endpoint. Multivariate analyses showed that active intraoperative warming (p=0.008), early stop of intravenous fluids (p=0.0001), and early removal of urinary catheter (p=0.0001) were associated to a shorter TRD, while early stop of intravenous fluids (p<0.001) also reduced morbidity. When the analysis was restricted to pre- and intraoperative items, removal of NGT at the end of surgery had an independent role to shorten TRD (p<0.001) and to reduce overall morbidity (p=0.019), while the absence of oral bowel preparation reduced postoperative overall morbidity (p=0.021). In implementing an ERAS pathway, hospitals could initially focus on active intraoperative warming, early stop of intravenous fluids, early removal of urinary catheter, removal of NGT at the end of surgery, and absence of oral bowel preparation, keeping on continuous effort to apply the complete ERAS protocol.

Urinary retention in early urinary catheter removal after colorectal surgery

BackgroundHigh urinary infection (UTI) rate (12%) for our rectal surgery prompted practice change to early catheter removal (postoperative day 2) and prophylactic tamsulosin. Here we report urinary retention (UR) and UTI after this change. MethodsRetrospective cohort study in male patients 50+ years undergoing elective colorectal surgery from July 2015 to July 2017. Multivariate regression was used to determine risk factors for urinary retention. Results157 patients, 57 without and 100 with tamsulosin had UR 11.46% and UTI 5.13%. Of all potential risk factors, ileus (OR 5.50, 95% CI: 1.86–16.24) was an independent risk factor for urinary retention. ConclusionsUrinary retention of 11% after colorectal resection is within literature range and associated with post-operative ileus. Tamsulosin did not affect UR in our small study sample. Early catheter removal was associated with decreased UTI rate.

Early Versus Late Trail of Catheter Removal in Patients with Urinary Retention Secondary to Benign Prostatic Hyperplasia under Tamsulosin Treatment

Objective: The main objective of this study is to evaluate the impact of early and late removal of urinary catheter after acute urine retention (AUR) in patients with benign prostatic hyperplasia (BPH) under tamsulosin treatment on the success of trial without catheter (TWOC). Materials and Methods: This is a prospective randomized study, 60 men with AUR secondary to BPH, after fulfilling the inclusion criteria in the absence of the exclusion criteria of the study were catheterized and then were randomly assigned to receive 0.4 mg tamsulosin hydrochloride for 3 days or 7 days, after that the catheter was removed and the ability to void unaided assessed. Results: Eighteen men taking tamsulosin for 3 days and 21 patients taking tamsulosin for 7 days did not require recatheterization on the day of the TWOC (60% and 70%, respectively, P = 0.417). Complication as urinary tract infection, urine leakage, hematuria, or catheter obstruction occurred in five (16.7%) men who received tamsulosin for 3 days and 13 (43.3%) men who received tamsulosin for 7 days (P = 0.024). Conclusions: Men catheterized for AUR can void successfully after catheter removal if treated with alpha-1 blockade, and success rate of TWOC is controversial regarding the duration of catheterization. However, the complications were increased with period of catheterization.

Meatal cleaning with antiseptics for the prevention ofcatheter-associated urinary tract infections: Adiscussion paper.

Urinary tract infections related to indwelling urinary catheters, known as catheter-associated urinary tract infections (CAUTI), are largely preventable healthcare-associated infections (HAI). Healthcare-associated infections including CAUTI are associated with prolonged hospital stay, increased resistance of microorganisms to antimicrobials, increased morbidity and mortality as well as additional financial burden on health care systems, patients and their families. While the optimal aim for patients and the health care system is to prevent CAUTI using measures such as reducing unnecessary placement and early removal of urinary catheters, there is evidence that cleaning of the meatal or peri-urethral area with antiseptic prior to catheter insertion and care of this area while the catheter is insitu has the potential to reduce CAUTI. Evidence suggests that meatal cleaning with antiseptics while the catheter is insitu is non-beneficial in reducing CAUTI but current international and Australian guidelines for infection control professionals identifies that the benefit of antiseptic solution versus non-antiseptic solution for meatal or peri-urethral cleaning before urinary catheter insertion remains unresolved. This discussion paper therefore focuses primarily on antiseptic meatal cleaning prior to urinary catheter insertion in preventing CAUTI. Using evidence from a recently published systematic review and meta-analysis of the literature, this paper discusses the scope of the problem and limitations in the evidence regarding the effectiveness of antiseptics for preventing CAUTI and finally, proposes a way forward through the undertaking of a rigorously conducted randomised controlled trial aimed at evaluating the effectiveness and cost-effectiveness of antiseptic meatal cleaning for prevention of CAUTI.

Early removal of urinary catheter in postoperative patients with epidural analgesia

Early removal of urinary catheter in postoperative patients with epidural analgesia

Enhanced recovery after elective caesarean: a rapid review of clinical protocols, and an umbrella review of systematic reviews

BackgroundThe rate of elective Caesarean Section (CS) is rising in many countries. Many obstetric units in the UK have either introduced or are planning to introduce enhanced recovery (ER) as a means of reducing length of stay for planned CS. However, to date there has been very little evidence produced regarding the necessary components of ER for the obstetric population. We conducted a rapid review of the composition of published ER pathways for elective CS and undertook an umbrella review of systematic reviews evaluating ER components and pathways in any surgical setting.MethodsPathways were identified using MEDLINE, EMBASE and the National Guideline Clearing House, appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool and their components tabulated. Systematic reviews were identified using the Cochrane Library and Database of s of Reviews of Effects (DARE) and appraised using The Grading of Recommendations Assessment, Development and Evaluation (GRADE). Two reviewers aggregated summaries of findings for Length of Stay (LoS).ResultsFive clinical protocols were identified, involving a total of 25 clinical components; 3/25 components were common to all five pathways (early oral intake, mobilization and removal of urinary catheter). AGREE II scores were generally low. Systematic reviews of single components found that minimally invasive Joel-Cohen surgical technique, early catheter removal and post-operative antibiotic prophylaxis reduced LoS after CS most significantly by around half to 1 and a half days. Ten meta-analyses of multi-component Enhanced Recovery after Surgery (ERAS) packages demonstrated reductions in LoS of between 1 and 4 days. The quality of evidence was mostly low or moderate.ConclusionsFurther research is needed to develop, using formal methods, and evaluate pathways for enhanced recovery in elective CS. Appropriate quality improvement packages are needed to optimise their implementation.

Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer

BackgroundEnhanced recovery after surgery (ERAS) protocols are now well-known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity. However, the efficacy and safety of ERAS protocols for patients with obstructive colorectal cancer have yet to be clarified.MethodsWe evaluated 122 consecutive resections for obstructive colorectal cancer performed between July 2008 and November 2012 at Tokyo Metropolitan Bokutoh Hospital. Patients with rupture or impending rupture and those who received simple colostomy were excluded. The first set of 42 patients was treated based on traditional protocols, and the latter 80 according to modified ERAS protocols. The main endpoints were length of postoperative hospital stay, postoperative short-term morbidity, rate of readmission within 30 days, and mortality. Differences in modified ERAS protocols relative to traditional care include intensive preoperative counseling (by both surgeons and anesthesiologists), perioperative fluid management (avoidance of sodium/fluid overload), shortening of postoperative fasting period and early provision of oral nutrition, intraoperative warm air body heating, enforced postoperative mobilization, stimulation of gut motility, early removal of urinary catheter, and a multidisciplinary team approach to care.ResultsMedian (interquartile range) postoperative hospital stay was 10 (10–14.25) days in the traditional group, and seven (7–8.75) days in the ERAS group, showing a 3-day reduction in hospital stay (p < 0.01). According to the Clavien-Dindo classification, overall incidences of grade 2 or higher postoperative complications for the traditional and ERAS groups were 15 and 10% (p = 0.48), and 30-day readmission rates were 0 and 1.3% (p = 1.00), respectively. As for mortality, one patient in the traditional group died and none in the ERAS group (p = 0.34).ConclusionModified ERAS protocols for obstructive colorectal cancer reduced hospital stay without adversely affecting morbidity, indicating that ERAS protocols are feasible for patients with obstructive colorectal cancer.

Old habits die hard; does early urinary catheter removal affect kidney size, bacteriuria and UTI after renal transplantation?

Introduction: Renal transplantation is the treatment of choice in chronic renal failure patients. Objectives: The purpose of this study was to evaluate the impact of urinary catheter removal time on transplanted kidney size and incidence of asymptomatic bacteriuria and urinary tract infections (UTIs). Patients and Methods: This retrospective cohort study evaluated the clinical outcomes of 109 consecutive live donor renal transplant recipients from December 2011 to July 2014. Routine ultrasound examinations were performed on donor’s kidney prior to operation and one month later. Kidney volume was calculated. UTI and bacteriuria were evaluated one month later. Patients were divided into two groups based on time of Foley catheter removal (before and after fifth day posttransplantation). Results: In this study 74 males (67.9%) and 35 females (32.1%) were evaluated. Sixty-six patients (57.92%) were in group 1. None of the patients with positive urine culture had UTI but bacteriuria occurred in all of them (21.1%). Bacteriuria time after transplantation and catheter removal was significantly later in group 1 and it was not different in female group but they were later in male group. The mean renal volume increase was positively correlated to renal transplant recipient and donor’s age and donor’s body mass index (BMI) (P<0.05). Conclusion: This study showed that the time of catheter removal after kidney transplantation does not affect incidence of UTI but increases the probability of bacteria in men whose catheter was removed within 5 days after transplantation. We also found that the renal volume change is not associated with catheter removal time and bacteriuria.

Enhanced Recovery Program in High-Risk Patients Undergoing Colorectal Surgery: Results from the PeriOperative Italian Society Registry.

Enhanced recovery after surgery (ERAS) pathways represent the optimal approach for patients undergoing colorectal surgery. Elderly or low physical status patients have been often excluded from ERAS pathways because considered at high risk. The aim of this study is to assess the adherence to ERAS protocol and its impact on short-term postoperative outcome in patients with different surgical risk undergoing elective colorectal resection. Prospectively collected data entered in an electronic Italian registry specifically designed for ERAS were reviewed. Patients were divided into four groups according to age (70-year-old cutoff) and preoperative physical status as measured by the ASA grade (I-II vs. III-IV). Adherence to 18 ERAS elements and postoperative outcomes were compared between groups. Regression analysis was used to identify independent factors associated with improved outcomes. Eleven Italian hospitals reported data on 706 patients undergoing elective colorectal surgery within an ERAS protocol. Patients with low physical status had reduced adherence to preoperative carbohydrate loading, epidural analgesia, PONV prophylaxis, and early urinary catheter removal. No difference was found between groups for adherence to other perioperative elements. Major complications occurred in 37 (5.2%) patients without significant differences among groups (p=0.384). Median (IQR) time to readiness for discharge (TRD) was 4 (3-6) days, length of hospital stay (LOS) was 6 (4-7) days, and both were significantly shorter by only 1day in the groups of younger patients (p<0.001). At multivariate analysis, laparoscopy increased adherence to ERAS items and reduced TRD, LOS, and morbidity. A high ASA grade was significantly associated with lower adherence, whereas older age significantly prolonged TRD and LOS. ERAS pathway can be safely applied in elderly and low physical status patients yielding slight differences in postoperative morbidity and time to recover. Laparoscopy was independently associated with increased adherence to ERAS protocol and improved short-term postoperative outcome.

An Unexpected Benefit: Does Early Urinary Catheter Removal Reduce the Risk of Surface Dependent Pressure Ulcers in the Critically Ill?

An Unexpected Benefit: Does Early Urinary Catheter Removal Reduce the Risk of Surface Dependent Pressure Ulcers in the Critically Ill?

Early removal of urinary catheter after excision and primary anastomosis in anterior urethral stricture.

To investigate the feasibility of removing the urinary catheter 7 days after excision and primary anastomosis (EPA) performed with the indication of anterior urethral stricture disease. Retrospective review of medical records of the patients who had undergone EPA between January 2005 and December 2010 was performed. These patients were divided into 2 groups: Group 1 (urethral catheter removed on or before 7. postoperative day) and Group 2 (urethral catheter removed on 8. postoperative day or later). We compared 2 groups as for the frequency of extravasation as detected on retrograde pericatheter urethrogram (PUG) and recurrence rate till the last follow-up. PUG was performed on an average day 7 and 14 in Groups 1 (n=102) and 2 (n=134), respectively followed by removal of the catheter. Extravasation on the first PUG was detected in 6.8% of the patients in Group 1, and in 4.5% of the cases in Group 2 had extravasation on the first PUG. Urethral catheter was left in situ in these patients and a repeat PUG after one week was performed which was normal in all cases. The incidence of extravasation and recurrence rate did not differ significantly whether catheter was removed on day 7 or 14 (6.8% vs. 4.5% and 4.9% vs. 5.2% respectively) (p>0.5). We conclude that removal of the catheter on postoperative day 7 after EPA does not increase the rate of extravasation and recurrence during long-term follow-up. Urethral catheter restricts physical activity in the postoperative period which is bothersome to the patient. Hence early removal of a catheter should be offered to men after EPA.

Risk factors for healthcare-acquired urinary tract infections caused by multi-drug resistant microorganisms

Healthcare-acquired urinary tract infections (HAUTI) make up to 40% of all healthcareacquired infections and contribute significantly to hospital morbidity, mortality, and overall cost of treatment. The aim of our study was to investigate possible risk factors for development of HAUTI caused by multi-drug resistant pathogens. The prospective case-control study in a large tertiary-care hospital was conducted during a five-year period. The cases were patients with HAUTI caused by multi-drug resistant (MDR) pathogens, and the controls were patients with HAUTI caused by non-MDR pathogens. There were 562 (62.6%) patients with MDR isolates and 336 (37.4%) patients with non-MDR isolates in the study. There were four significant predictors of HAUTI caused by MDR pathogens: hospitalization before insertion of urinary catheter for more than eight days (ORadjusted = 2.763; 95% CI = 1.352–5.647; p = 0.005), hospitalization for more than 15 days (ORadjusted = 2.144; 95% CI = 1.547–2.970; p < 0.001), previous stay in another department (intensive care units, other wards or hospitals) (ORadjusted = 2.147; 95% CI = 1.585–2.908; p < 0.001), and cancer of various localizations (ORadjusted = 2.313; 95% CI = 1.255–4.262; p = 0.007). Early removal of urinary catheter and reduction of time spent in a hospital or in an ICU could contribute to a decrease in the rate of HAUTI caused by MDR pathogens.

Success of a urinary catheter insertion team in reducing urinary infections in the ICU

About 8-21 % of hospital infections in ICUs are urinary [1,2], 80 % of them being associated with the use of urinary catheters [3]. Several studies show that the early removal of urinary catheters reduces the rate of urinary tract infection. However, critically ill patients who require this device do not have the option to remove. For this group, the best preventive measure seems to be educative activity for the nursing staff responsible for the insertion and manipulation of this device.

Early removal of urinary catheters after rectal surgery is associated with increased urinary retention.

Urinary retention after rectal resection is common and managed prophylactically by prolonging urinary catheterization. However, because indwelling urinary catheterization is a well-established risk factor for urinary tract infection, the ideal timing for urinary catheter removal following a rectal resection is unknown. We hypothesized that early urinary catheter removal (on or before postoperative day 2) would be associated with urinary retention. This study is a retrospective review of medical records. This study was conducted at a colorectal surgery service at a tertiary care academic teaching hospital. Adults undergoing rectal resection operations by colorectal surgeons in 2005 to 2010 were selected. The primary outcome measured was urinary retention. Of 205 patients included, 41 (20%) developed urinary retention. Male sex (OR, 3.9; 95% CI, 1.7-9), increased intraoperative intravenous fluid (OR for each liter, 1.2; 95% CI, 1.04-1.48), and urinary catheter removal on postoperative day 2 or earlier (OR, 3.8; 95% CI, 1.4-10.5) were associated with urinary retention on multivariable analysis. Early catheter removal was not associated with decreased urinary tract infection rates (p = 0.29) but was associated with shorter length of stay (6.5 vs 8.9 days; p = 0.005). The retrospective nature of this study did not allow for a precise definition of urinary retention. Preoperative urinary function was not available, and the patient sample was heterogeneous, including several indications for rectal resection. Urinary catheters were not removed per protocol and therefore subject to bias. The study is likely underpowered to detect differences in urinary tract infection between urinary catheter removal groups. In patients undergoing rectal resection, we found that urinary catheter removal on or before postoperative day 2 was associated with urinary retention (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A172).