The Risk Factors Influencing the Development of Acute Urinalry Retention After Rectal Cancer Resection

Jung Myun Kwak, MD PhD, Seon Hahn Kim, MD PhD, Se Jin Baek, MD, Jae Seung Cho, MD, Jin Kim, MD PhD, Sung Soo Park, MD PhD, Sung Ock Suh, MD Phd. Korea University Anam Hospital

INTRODUCTION: It has been demonstrated that damage to the pelvic autonomic nerves resulting from radical pelvic dissection is the most important cause of acute postoperative urinary retention. The aim of this study was to evaluate the incidence and risk factors of acute urinary retention after minimally invasive surgery for rectal cancer patients.
METHODS: Using data from a prospective database of all operation performed in our department, we retrospectively analyzed data from 124 robotic and 119 laparoscopic rectal cancer resections between July 2007 and August 2010. Acute urinary retention is defined by reinsertion of any urinary catheter due to the inability to void after removal of Foley catheter in postoperative day 1 or 2.
RESULTS: A total of 243 (172 males) patients at a mean age of 60 years were included in the study. Acute urinary retention occurred in 37 patients and the overall prevalence was 15.2%. Gender, old age (> 65), ASA, BMI, prolonged operation time (> 4 hours), type of operation, tumor location, and stage were not associated with acute postoperative urinary retention. Fifteen (12.1%) of 124 patients who underwent robotic procedure experienced acute urinary retention comparing with 22 (18.5%) of 119 patients who underwent laparoscopic procedure (P=0.166). Acute urinary retention occurred more frequently when Foley catheter was removed in postoperative day 1 (24 of 112 patients, 21.4%) compared to that in day 2 (13 of 131 patients, 9.9%) (Odd Ratio 2.476, confidence interval 1.194-5.133; P=0.015). Normal voiding returned within 1 month in 97% of patients.
CONCLUSIONS: Although Foley catheter may be safely removed on early postoperative period, it is better not to hasten the catheter removal. Large, prospective studies are needed to confirm whether the robotic surgery can improve the voiding problem after rectal cancer resection.