Urinary Catheter Management

Abstract

After colorectal resection surgery, early urinary catheter removal has been promoted as a part of the national Surgical Care Improvement Project. However, the decrease in urinary tract infection expected with this strategy must be balanced against an increased risk for urinary retention. A systematic review of the literature was undertaken to summarize the evidence for and against early postoperative urinary catheter removal. For nonpelvic colorectal resection, the evidence supports removal of the catheter on postoperative day 1 for patients who are not at high risk for urinary retention, including patients with thoracic epidurals. For mid-to-low rectal surgery, the risk of urinary retention is increased, and catheter removal on day 3 to day 6 is recommended; however, the exact timing of removal cannot be recommended based on current studies.

Keywords

urinary catheterization - postoperative care - colorectal surgery

• References

• 1 Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000; 28 (1) 68-75
• 2 Binhas M, Motamed C, Hawajri N, Yiou R, Marty J. Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit. Ann Fr Anesth Reanim 2011; 30 (2) 122-125
• 3 Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg 2008; 143 (6) 551-557
• 4 Specifications Manual for National Hospital Inpatient Quality Measures, v4.2b. Available at: http://www.jointcommission.org/specifications-manual-for-national-hospital-inpatient-quality-measures.aspx . Accessed July 10, 2013
• 5 Changchien CR, Yeh CY, Huang ST, Hsieh ML, Chen JS, Tang R. Postoperative urinary retention after primary colorectal cancer resection via laparotomy: a prospective study of 2,355 consecutive patients. Dis Colon Rectum 2007; 50 (10) 1688-1696
• 6 Oberst MT, Graham D, Geller NL, Stearns Jr MW, Tiernan E. Catheter management programs and postoperative urinary dysfunction. Res Nurs Health 1981; 4 (1) 175-181
• 7 Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 2009; 110 (5) 1139-1157
• 8 Junginger T, Kneist W, Heintz A. Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision. Dis Colon Rectum 2003; 46 (5) 621-628
• 9 Havenga K, Maas CP, DeRuiter MC, Welvaart K, Trimbos JB. Avoiding long-term disturbance to bladder and sexual function in pelvic surgery, particularly with rectal cancer. Semin Surg Oncol 2000; 18 (3) 235-243
• 10 Lange MM, Maas CP, Marijnen CA , et al; Cooperative Clinical Investigators of the Dutch Total Mesorectal Excision Trial. Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg 2008; 95 (8) 1020-1028
• 11 Sterk P, Shekarriz B, Günter S , et al. Voiding and sexual dysfunction after deep rectal resection and total mesorectal excision: prospective study on 52 patients. Int J Colorectal Dis 2005; 20 (5) 423-427
• 12 Chaudhri S, Maruthachalam K, Kaiser A, Robson W, Pickard RS, Horgan AF. Successful voiding after trial without catheter is not synonymous with recovery of bladder function after colorectal surgery. Dis Colon Rectum 2006; 49 (7) 1066-1070
• 13 Kneist W, Heintz A, Junginger T. Major urinary dysfunction after mesorectal excision for rectal carcinoma. Br J Surg 2005; 92 (2) 230-234
• 14 Gould C, Umscheid C, Agarwal R, Kuntz G, Pegues D. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009. Atlanta, GA: Centers for Disease Control; 2009
• 15 Zaouter C, Kaneva P, Carli F. Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia. Reg Anesth Pain Med 2009; 34 (6) 542-548
• 16 Benoist S, Panis Y, Denet C, Mauvais F, Mariani P, Valleur P. Optimal duration of urinary drainage after rectal resection: a randomized controlled trial. Surgery 1999; 125 (2) 135-141
• 17 Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 2010; 29 (4) 434-440
• 18 Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 2007; 245 (6) 867-872
• 19 Basse L, Hjort Jakobsen D, Billesbølle P, Werner M, Kehlet H. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000; 232 (1) 51-57
• 20 Kahokehr A, Sammour T, Zargar-Shoshtari K, Srinivasa S, Hill AG. Recovery after open and laparoscopic right hemicolectomy: a comparison. J Surg Res 2010; 162 (1) 11-16
• 21 Wald HL, Kramer AM. Feasibility of audit and feedback to reduce postoperative urinary catheter duration. J Hosp Med 2011; 6 (4) 183-189
• 22 Zmora O, Madbouly K, Tulchinsky H, Hussein A, Khaikin M. Urinary bladder catheter drainage following pelvic surgery—is it necessary for that long?. Dis Colon Rectum 2010; 53 (3) 321-326
• 23 Jang JH, Kang SB, Lee SM, Park JS, Kim DW, Ahn S. Randomized controlled trial of tamsulosin for prevention of acute voiding difficulty after rectal cancer surgery. World J Surg 2012; 36 (11) 2730-2737
• 24 Basse L, Werner M, Kehlet H. Is urinary drainage necessary during continuous epidural analgesia after colonic resection?. Reg Anesth Pain Med 2000; 25 (5) 498-501
• 25 Basse L, Thorbøl JE, Løssl K, Kehlet H. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 2004; 47 (3) 271-277 , discussion 277–278
• 26 Ladak SS, Katznelson R, Muscat M, Sawhney M, Beattie WS, O'Leary G. Incidence of urinary retention in patients with thoracic patient-controlled epidural analgesia (TPCEA) undergoing thoracotomy. Pain Manag Nurs 2009; 10 (2) 94-98
• 27 Niël-Weise BS, van den Broek PJ. Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev 2005; (3) CD004203
• 28 Branagan GW, Moran BJ. Published evidence favors the use of suprapubic catheters in pelvic colorectal surgery. Dis Colon Rectum 2002; 45 (8) 1104-1108
• 29 Hooton TM, Bradley SF, Cardenas DD , et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010; 50 (5) 625-663
• 30 Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010; 31 (4) 319-326