Total Mesorectal Excision in Rectal Cancer and Optimal Duration of Urinary Catheter Drainage

Jagannath Dixit, MBBSMSMchFICSFIAGES. HCG, Bengaluru

BACK GROUND; total mesorctal excison(TME) minimizes urinary dysfunction, facilitating autonomic nerve preservation during rectal caancer surgery. However urinary catheter drainage for several days after TME is acommon surgical practice, despite insufficient evidence supporting its routine use

PURPOSE The aim of this study was to evaluate optimal duration of urinary catheter drainage after TME

METHODS Between april 2011 to july 2014, 120 consecutive patients underwent resection for Rectal cancer. Among these 90 patients who was ASA score of 1 to 3 underwent elective TME with colorectal or coloanal anastomosis were included . Patients with combined pelvic surgery (n=8). Injury to urinary system (n=4),post operative complication more than Dindo III (n=6) and known urinary disease (n=7) were excluded so remaining 65 patients were evaluated. Posoperative urinary retention was defined as requiring reinsertion of indwelling catheter because of inability to void with residual urine volume more than 400 ml RESULTS The incidence of acute urinary retention was 4.8%(3 patients). In univariate analysis, age, sex,ASA classification, surgical procedure (low anterior resection vs coloanal anastomosis),surgical approach(laproscopy vs open/conversion),TNM stage,distance from analverge, rate of neoadjuvant radiation therapy,duration of urinary catherisation and operative period were not associated with urinary retention. According duration of urinary catherisation, patient assigned to 2 groups (1day vs 2 days) . No signifcant differences were obseved between the 2 groups regarding urinary retention 4.85 in dayvs 2.95 in more than 2 days which is stastically not significant

CONCLUSION Our study showed that urinary catheter can be safely removed on post operative day 1 for rectal cancer to avoid UTI and encourage early ambulation

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