Laparoscopic Colonic Resection Without Urinary Drainage: Is It "Feasible"?

BACKGROUND: Urinary retention following colorectal surgery is a known and costly morbidity. Increasing effort is being made to streamline patient recovery following colon resection, though the ideal timing and duration of urinary catheterization (UC) and its effect on urinary retention (UR) and urinary tract infection (UTI) remain controversial.

METHODS: Our program prospectively enrolled patients undergoing elective segmental colon resection through our "fast track" protocol, in which UC is completely avoided unless required for fluid management or to facilitate dissection. Patient demographics and perioperative data including type of analgesia, duration of anesthesia, timing of UC, and rates of perioperative UR and UTI were prospectively recorded.

RESULTS: Sixty-five patients met inclusion criteria. Sigmoid colectomy was the most common procedure (76.9 %). The average duration of anesthesia was 274 min, and epidural analgesia was employed in 32 (49.2 %). Twenty-two patients (33.8 %) required temporary perioperative UC. All patients left the operating room without a urinary catheter. Urinary retention occurred in six patients (9.2 %, three with and three without epidural analgesia). One patient who was not catheterized developed a UTI (1.5 %). There was no perioperative mortality. Overall, 39 (60.0 %) patients successfully underwent segmental colon resection and hospital discharge without any UC.

CONCLUSIONS: "Fast track" enhanced recovery after elective segmental colon resection without requiring UC is safe and feasible. Epidural analgesia does not mandate the use of UC. In light of the considerable morbidity and cost of UR and UTI, this approach merits further investigation for this patient population.