Suprapubic bladder drainage in colorectal surgery

Suprapubic bladder drainage in elective colorectal surgery

Suprapubic bladder drainage was assessed in 399 patients, following surgery of the rectum and sigmoid colon. An Argyle-Ingram catheter no. 16 French was inserted after the laparotomy incision had been made. The bladder was drained continuously for 24 hours, after which the catheter was closed and reopened every 6 hours for 10 minutes. The catheter was removed when the postvoided volume became less than 50 ml on each of two subsequent measurements. Abdominoperineal excision required the longest drainage period. Urethral catheterization became necessary in 13 men and six women because of persistent or recurrent urinary retention. Failures of suprapubic drainage made urethral catheterization necessary in 17 of 31 patients. Uroperitoneum, due to leakage from the bladder after removal of the suprapubic catheter, was seen in one patient with infravesical obstruction and bladder diverticula. The patient recovered after relaparotomy and suture of the bladder. Suprapubic drainage is recommended because it permits spontaneous voiding. Urethral instrumentation is avoided in most cases. Residual volume can be measured without urethral catheterization. Complications are few, and discomfort to the patient is seen in no more than 1 percent.

Rectal prolapse and anal incontinence treated with a modified Roscoe Graham operation

The results of abdominal mobilization of the rectum and repair of the pelvic floor behind the anorectal junction are reported in 23 patients with rectal prolapse, being accompanied by some form of anal incontinence in 12. Within 20 months, on the average, three patients had recurrent prolapse. Two thirds of the patients with incontinence for solid and/or fluid feces were cured for prolapse as well as incontinence. Seven became constipated, while 14 were fully satisfied. Seven of eight patients with a highly reduced tone of the external sphincter before surgery had a marked improvement after surgery. The results do not differ greatly from those after the suspension operation or repair of the pelvic floor in front of the rectum, despite being more physiologic, but suggest that simultaneous suspension and abdominal repair of the pelvic floor may avoid the need for a secondary postanal repair from below in patients with persistent incontinence after suspension surgery. A controlled, randomized trial is advocated.