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Trilling B, Tidadini F, Lakkis Z, Jafari M, Germain A, Rullier E, Lefevre J, Tuech JJ, Kartheuser A, Leonard D, Prudhomme M, Piessen G, Regimbeau JM, Cotte E, Duprez D, Badic B, Panis Y, Rivoire M, Meunier B, Portier G, Bosson JL, Vilotitch A, Foote A, Caspar Y, Rouanet P, Faucheron JL. Suprapubic versus transurethral catheterization for bladder drainage in male rectal cancer surgery (GRECCAR10), a randomized clinical trial. Tech Coloproctol 2024; 28:77. [PMID: 38954131 DOI: 10.1007/s10151-024-02950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Bladder drainage is systematically used in rectal cancer surgery; however, the optimal type of drainage, transurethral catheterization (TUC) or suprapubic catheterization (SPC), is still controversial. The aim was to compare the rates of urinary tract infection on the fourth postoperative day (POD4) between TUC and SPC, after rectal cancer surgery regardless of the day of removal of the urinary drain. METHODS This randomized clinical trial in 19 expert colorectal surgery centers in France and Belgium was performed between October 2016 and October 2019 and included 240 men (with normal or subnormal voiding function) undergoing mesorectal excision with low anastomosis for rectal cancer. Patients were followed at postoperative days 4, 30, and 180. RESULTS In 208 patients (median age 66 years [IQR 58-71]) randomized to TUC (n = 99) or SPC (n = 109), the rate of urinary infection at POD4 was not significantly different whatever the type of drainage (11/99 (11.1%) vs. 8/109 (7.3%), 95% CI, - 4.2% to 11.7%; p = 0.35). There was significantly more pyuria in the TUC group (79/99 (79.0%) vs. (60/109 (60.9%), 95% CI, 5.7-30.0%; p = 0.004). No difference in bacteriuria was observed between the groups. Patients in the TUC group had a shorter duration of catheterization (median 4 [2-5] vs. 4 [3-5] days; p = 0.002). Drainage complications were more frequent in the SPC group at all followup visits. CONCLUSIONS TUC should be preferred over SPC in male patients undergoing surgery for mid and/or lower rectal cancers, owing to the lower rate of complications and shorter duration of catheterization. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02922647.
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Affiliation(s)
- B Trilling
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
- TIMC-IMAG - CNRS UMR 5525, University Grenoble Alpes, 38000, Grenoble, France
| | - F Tidadini
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
- Lyon Center for Innovation in Cancer, Lyon 1 University, EA 3738, Lyon, France
| | - Z Lakkis
- Department of Surgical Oncology, Besancon University Hospital, Besancon, France
| | - M Jafari
- Department of Digestive and Oncological Surgery, Oscar Lambret Center, Lille, France
| | - A Germain
- Digestive Surgery Department, University Hospital of Nancy, Nancy, France
| | - E Rullier
- Digestive Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - J Lefevre
- Digestive Surgery Department, Saint-Antoine Hospital, APHP, Paris, France
| | - J J Tuech
- Digestive Surgery Department, Rouen University Hospital, Rouen, France
| | - A Kartheuser
- Department of Medical Oncology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - D Leonard
- Department of Medical Oncology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - M Prudhomme
- Department of Digestive Surgery, Nîmes, University Hospital, Nîmes, France
| | - G Piessen
- Digestive Surgery Department, University Hospital of Lille, Lille, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - E Cotte
- Digestive Surgery Department, Lyon-Sud University Hospital, Pierre-Bénite, France
| | - D Duprez
- Digestive Surgery Department, Annecy-Genevois Hospital, Metz-Tessy, France
| | - B Badic
- Department of General and Digestive Surgery, Brest, University Hospital, Brest, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, AP-HP, Clichy, France
| | - M Rivoire
- Department of Surgical Oncology, Léon Bérard Center, Lyon, France
| | - B Meunier
- Department of Hepatobiliary and Digestive Surgery, Rennes University Hospital, Rennes, France
| | - G Portier
- Department of Digestive Surgery, Toulouse Purpan University Hospital, Toulouse, France
| | - J L Bosson
- Department of Medical Information, Grenoble-Alpes University Hospital, Grenoble, France
- Colorectal Unit, Department of Surgery, Hôpital Michallon, CHU de Grenoble-Alpes, CS 10217, 38043, Grenoble Cedex, France
| | - A Vilotitch
- Department of Medical Information, Grenoble-Alpes University Hospital, Grenoble, France
| | - A Foote
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - Y Caspar
- Laboratory of Bacteriology, Grenoble-Alpes University Hospital, Grenoble, France
| | - P Rouanet
- Surgical Oncology Department, Montpellier Cancer Institute (ICM), Montpellier, France
| | - J L Faucheron
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France.
- TIMC-IMAG - CNRS UMR 5525, University Grenoble Alpes, 38000, Grenoble, France.
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Risk factors for postoperative urinary retention in patients undergoing colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:2409-2420. [PMID: 36357736 DOI: 10.1007/s00384-022-04281-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE Postoperative urinary retention (POUR) is a common complication following colorectal surgery. The incidence of POUR among colorectal surgery patients varies widely, and the risk factors and outcomes of POUR are also debatable. This meta-analysis aims to systematically evaluate the risk factors for POUR in patients after colorectal surgery. METHODS PubMed, Web of Science, the Cochrane Library, Embase, Medline, and Chinese databases (CBM, CNKI, and WanFang Databases) were searched to identify relevant cohort studies (from inception to August 2022). Two researchers independently conducted literature quality evaluation and data extraction. All data were analyzed by using the Review Manager 5.4 software. RESULTS Nineteen studies with 101,025 patients were included in this meta-analysis. The risk factors for POUR in colorectal surgery patients were male sex, older age, diabetes mellitus, urological diseases, tumor location in the lower rectum, APR, laparoscopic surgery, operation time ≥ 4 h, postoperative date of urinary catheter removal, excessive intraoperative intravenous fluid volume, and postoperative ileus. The postoperative anastomotic leak, on the other hand, was not a risk factor for POUR. CONCLUSIONS Multiple risk factors influence the incidence of POUR in patients undergoing colorectal surgery. To reduce the incidence of POUR in colorectal surgery patients, medical staff should identify risk factors early and enforce interventions to prevent them.
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Retrospective risk analysis for acute urinary dysfunction after laparoscopic rectal cancer surgery in patients receiving epidural analgesia. Int J Colorectal Dis 2021; 36:169-175. [PMID: 32935186 DOI: 10.1007/s00384-020-03745-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Urinary dysfunction (UD) is a frequent complication following rectal surgery. The aim of the present study was to investigate the risk factors for acute UD after laparoscopic low anterior resection (LALAR) for rectal cancer in patients receiving epidural analgesia. METHODS A retrospective study was conducted on 131 patients who underwent LALAR among those receiving epidural analgesia in a single institution between October 2008 and December 2019. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with acute UD. RESULTS The overall incidence of acute UD was 16.0% (21/131). Univariate analysis showed that older age (P = 0.016) and earlier urinary catheter removal (P = 0.036) were associated with acute UD. Multivariate logistic regression analysis revealed that older age (10-year increments; odds ratio (OR) 2.046, 95% confidence interval (CI) 1.171-3.543, P = 0.011), urinary catheter removal before epidural analgesia discontinuation (OR 6.393, 95% CI 1.540-26.534, P = 0.011), and a large tumor circumference rate (10% increments; OR 1.263, 95% CI 1.043-1.530, P = 0.017) were independent risk factors for acute UD. CONCLUSION Our findings suggest that older age, early removal of urinal catheter before epidural analgesia discontinuation, and large tumor circumference rate are risk factors of acute UD after LALAR for rectal cancer in patients receiving epidural analgesia.
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Zhu KJ, Thanigasalam R, Solomon MJ. Preoperative urinary function does not predict postoperative acute urinary retention in men after rectal resection. Colorectal Dis 2020; 22:2260-2269. [PMID: 32691944 DOI: 10.1111/codi.15280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022]
Abstract
AIM Acute urinary retention (AUR) is a well-known complication after rectal surgery. It can be associated with additional morbidity. Causes of postoperative AUR are often multifactorial - involving patient-, pathology- and treatment-related factors. A proportion of men undergoing total mesorectal excision (TME) have preexisting urinary dysfunction and this may predispose to AUR. The aim of this study was to prospectively assess the influence of preoperative urinary function on postoperative AUR in men undergoing TME. METHOD A prospective multicentre cohort study was conducted. All adult men undergoing rectal resection between June 2016 and January 2018 were recruited. Combined pelvic resections, inability to void per urethra and emergency surgery were excluded. Preoperative urinary function was assessed with uroflowmetry, prostate ultrasound and the International Prostate Symptom Score (IPSS). The incidence of postoperative AUR, urinary tract infection (UTI) and length of hospital stay (LOS) were measured. RESULTS Seventy-seven patients (mean age 61 years) were recruited. The overall incidence of AUR was 21%. Preoperative urinary function, IPSS and past urological history were not predictive for postoperative AUR. AUR was not associated with UTI and did not affect LOS. Patients with UTI had a higher intravesical protrusion of the prostate. CONCLUSION Preoperative urinary dysfunction in men is not predictive of postoperative AUR after TME. It should not preclude early trial of void after TME. AUR did not predispose to UTI, nor did it prolong LOS.
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Affiliation(s)
- K J Zhu
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, University of Sydney, Sydney, New South Wales, Australia
| | - R Thanigasalam
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Jane Hall S, Harrison S, Harding C, Reid S, Parkinson R. British Association of Urological Surgeons suprapubic catheter practice guidelines – revised. BJU Int 2020; 126:416-422. [PMID: 32463982 DOI: 10.1111/bju.15123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Simon Harrison
- Pinderfields General Hospital Wakefield West Yorkshire UK
| | | | - Sheilagh Reid
- Sheffield Teaching Hospitals Royal Hallamshire Hospital Broomhall Sheffield UK
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Roulet M, Delbarre B, Vénara A, Hamy A, Barbieux J. Urine drainage management in colorectal surgery. J Visc Surg 2020; 157:309-316. [PMID: 32446914 DOI: 10.1016/j.jviscsurg.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Enhanced recovery programs (ERP) is aimed at reducing a patient's surgical stress response, specifically by reducing the duration of catheterization. In cases of colorectal surgery, there is pronounced heterogeneity in urinary catheterization, which is largely explained by fear of acute urinary retention (AUR). OBJECTIVE The objective of the work is to report on the current literature on postoperative urinary catheterization following colorectal surgery, particularly with regard to the risk of AUR, and thereby contribute to the standardization of perioperative practices. RESULTS In colon surgery without preoperative urinary disorders, catheterization must not exceed 24h. In rectal surgery, catheter removal starting on postoperative D2 seems reasonable in the absence of AUR risk factor (RF). Male sex, past history of lower urinary tract obstruction, abdomino-perineal amputation (APA) and low rectal anastomosis are AUR risk factors that must be taken into account when deciding to withdraw the urinary catheter. While the role of a suprapubic catheter is not clearly defined, it may be of use following APA. The epidural catheter is another AUR risk factor, but it seems possible to withdraw the urinary catheter on postoperative D1, before the epidural catheter, provided that the other risk factors have been taken into full account. Lastly, up until now no satisfactorily conducted study has assessed the prophylactic value of systematic perioperative alpha-blocker treatment in colorectal surgery.
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Affiliation(s)
- M Roulet
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49100 Angers, France.
| | - B Delbarre
- Service de chirurgie urologique, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - A Vénara
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - A Hamy
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - J Barbieux
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
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Hamamoto H, Yamamoto M, Masubuchi S, Ishii M, Osumi W, Tanaka K, Okuda J, Uchiyama K. Male sex and anterior wall tumor location as risk factors for urinary dysfunction after laparoscopic rectal surgery. Surg Endosc 2019; 34:3567-3573. [DOI: 10.1007/s00464-019-07186-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 10/01/2019] [Indexed: 01/13/2023]
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Correlation Analyses of Computed Tomography and Magnetic Resonance Imaging for Calculation of Prostate Volume in Colorectal Cancer Patients with Voiding Problems Who Cannot Have Transrectal Ultrasonography. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7029450. [PMID: 31049353 PMCID: PMC6462342 DOI: 10.1155/2019/7029450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/26/2019] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the value of computed tomography (CT) and magnetic resonance imaging (MRI) in determining total prostate volume (TPV) for patients with colorectal cancer, as an alternative to transrectal ultrasonography (TRUS) of the prostate when TRUS is not an option. Methods We retrospectively evaluated the medical records of 122 male cancer patients who were referred to our urology department between 2014 and 2016 for voiding problems. They underwent colorectal surgery within 3 months; we estimated the correlations of the TPV measurements made using CT, MRI, and TRUS. A total of 122 TRUS, 88 MRI, and 34 CT images were reviewed repeatedly, twice by 2 independent urologists within 1 month after the initial evaluation. The correlations were statistically evaluated using a Bland-Altman plot and Spearman and Pearson correlation analyses. Results Overall median age was 70.5 years and the median TPV, as measured using TRUS, CT, and MRI, was 33.2, 43.4, and 30.1 mL, respectively. There was a good correlation in TPV measured with CT (coefficient >0.7) and MRI (>0.8). There was not a good correlation between TRUS and preoperative and postoperative CT/MRI; preoperative CT/MRI had a higher correlation (>0.7) than postoperative CT/MRI (>0.8). When stratified by prostate volume, preoperative CT (>0.58-0.59) correlated better for <30 mL and preoperative MRI (0.70-0.75) correlated better for ≥30 mL. Conclusions The study showed that preoperative MRI had the best correlation with TRUS, especially in prostates ≥30 mL despite overestimations in CT and MRI measurements compared with TRUS.
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Abstract
While colorectal surgery has been documented to have some of the highest complication rates in the surgical field, some of the more common, functional complications are often overlooked in the literature and in discussion with patients. Urinary, sexual, and defecatory dysfunction are common after colorectal surgery, especially after pelvic dissections, and may severely impact the postoperative quality of life for patients. These complications include urinary retention, erectile dysfunction, retrograde ejaculation, dyspareunia, infertility, and low anterior resection syndrome. The majority is rooted in autonomic nerve damage, both sympathetic and parasympathetic, that occurs during mobilization and resection of the sigmoid colon and rectum. While not all of these postoperative complications are preventable, treatment strategies have been developed to ameliorate the impact on quality of life. Given the high incidence and direct effect on patients, clinicians should be familiar with the etiology, prevention, and treatment strategies of these complications to provide the highest quality of care.
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Affiliation(s)
- Matthew D. Giglia
- Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sharon L. Stein
- Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Suprapubic bladder drainage and epidural catheters following abdominal surgery-A risk for urinary tract infections? PLoS One 2019; 14:e0209825. [PMID: 30673740 PMCID: PMC6343869 DOI: 10.1371/journal.pone.0209825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022] Open
Abstract
Background Epidural catheters are state of the art for postoperative analgesic in abdominal surgery. Due to neurolysis it can lead to postoperative urinary tract retention (POUR), which leads to prolonged bladder catheterization, which has an increased risk for urinary tract infections (UTI). Our aim was to identify the current perioperative management of urinary catheters and, second, to identify the optimal time of suprapubic bladder catheter removal in regard to the removal of the epidural catheter. Methods We sent a questionnaire to 102 German hospitals and analyzed the 83 received answers to evaluate the current handling of bladder drainage and epidural catheters. Then, we conducted a retrospective study including 501 patients, who received an epidural and suprapubic catheter after abdominal surgery at the University Hospital Würzburg. We divided the patients into three groups according to the point in time of suprapubic bladder drainage removal in regard to the removal of the epidural catheter and analyzed the onset of a UTI. Results Our survey showed that in almost all hospitals (98.8%), patients received an epidural catheter and a bladder drainage after abdominal surgery. The point in time of urinary catheter removal was equally distributed between before, simultaneously and after the removal of the epidural catheter (respectively: ~28–29%). The retrospective study showed a catheter-associated UTI in 6.7%. Women were affected significantly more often than men (10,7% versus 2,5%, p<0.001). There was a non-significant trend to more UTIs when the suprapubic catheter was removed after the epidural catheter (before: 5.7%, after: 8.4%). Conclusion The point in time of suprapubic bladder drainage removal in relation to the removal of the epidural catheter does not seem to correlate with the rate of UTIs. The current handling in Germany is inhomogeneous, so further studies to standardize treatment are recommended.
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Duchalais E, Larson DW, Machairas N, Mathis KL, Dozois EJ, Kelley SR. Outcomes of Early Removal of Urinary Catheter Following Rectal Resection for Cancer. Ann Surg Oncol 2018; 26:79-85. [PMID: 30353391 DOI: 10.1245/s10434-018-6822-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Early postoperative urinary catheter removal decreases urinary tract infection (UTI) rate and accelerates patient mobilization. The aim of this study is to determine the results of systematic urinary catheter removal on postoperative day (POD) 1 in patients undergoing rectal resection for cancer. PATIENTS AND METHODS Using a prospectively maintained database of 469 patients who underwent rectal resection for cancer, a retrospective review of all patients with urinary catheter removal on POD1 was conducted. Patients unable to void 6 h after catheter removal underwent in and out urinary catheterization (IOC group) and were compared with patients who voided spontaneously (non-IOC group) to determine risk factors for IOC. RESULTS A total of 417 patients were identified, including 274 (66%) men. Median age was 59 (50-68) years. Abdominoperineal resection (APR) was performed in 134 (32%), and complex surgery with resection of at least one other organ in 72 (17%) patients. Non-IOC and IOC groups included 245 (59%) and 172 (41%) patients, respectively. Five independent predictive factors for IOC were male gender, obesity, history of obstructive urinary disease, APR, and metastatic disease. The cumulative risk of IOC in patients with zero, one, two, and at least three risk factors was 8%, 31%, 52%, and 68% on POD1, and 2%, 12%, 23%, and 30% on POD5, respectively (p < 0.001). Thirteen patients (3%) developed UTI. CONCLUSIONS Early removal of urinary catheter resulted in 59% of patients voiding spontaneously with no need for IOC following rectal resection. Patients without any predictive factors had less than 10% risk of urinary dysfunction.
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Affiliation(s)
- E Duchalais
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
| | - N Machairas
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - K L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - E J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - S R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
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Zhao Y, Hou XL, Ding JH, Zhao K, Xu X, Dong GL. Early Urinary Dysfunction after Laparoscopic Rectal Cancer Surgery: Does Surgeons’ Learning Curve Matter? Am Surg 2018. [DOI: 10.1177/000313481808400516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Poor early urinary outcomes after laparoscopy were reported in studies comparing laparoscopic versus open rectal cancer surgery. One possible explanation was that these studies might include a number of patients on the laparoscopic surgeons’ learning curve. This study aims to evaluate whether the learning curve of laparoscopic rectal cancer surgery influences early postoperative urinary dysfunction. Between September 2009 and December 2014, 208 consecutive patients undergoing laparoscopic rectal resection for rectal cancer were enrolled in the present study. All the clinical data were obtained from a prospectively compiled database. The primary outcomes were the incidences of postoperative urinary retention (POUR) and major urinary dysfunction requiring long-term urinary catheterization. POUR and major urinary dysfunction rate were 20.2 per cent (42/208) and 4.3 per cent (9/208), respectively. The learning curve analysis for operative time using the moving average method showed stabilization at 80 cases. Surgeon experience was divided into two periods: learning curve period (1–80 cases) and experienced period (81–208 cases). Multivariate analysis showed that older age (OR = 3.250, P = 0.006) and learning curve (OR = 2.241, P = 0.024) were independent risk factors for POUR. Learning curve was not significantly associated with increased rates of major urinary dysfunction (OR = 3.378, P = 0.092). Learning curve is a significant risk factor for increased rate of POUR after laparoscopic rectal cancer surgery. Technical training may be key to shorten the learning curve and limit its impact on the postoperative urinary complications.
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Affiliation(s)
- Yong Zhao
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing, China; and the
| | - Xiao-Ling Hou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jian-Hua Ding
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing, China; and the
| | - Ke Zhao
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing, China; and the
| | - Xiao Xu
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Guang-Long Dong
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
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Abdelli A, Tillou X, Alves A, Menahem B. Genito-urinary sequelae after carcinological rectal resection: What to tell patients in 2017. J Visc Surg 2017; 154:93-104. [PMID: 28161008 DOI: 10.1016/j.jviscsurg.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although we have seen revolutionary changes with multi-disciplinary management of patients with rectal cancer, the evaluation of genito-urinary sequelae remains of great concern. Precise pre-operative evaluation with validated scores allows detection of urinary disorders in 16 to 23% of patients, and sexual disorders in nearly 35% of men and 50% of women. Regardless of the surgical approach, it is fundamental to respect the autonomic innervation during total mesorectal excision in order to prevent these sequelae. Identification of these nerves can be facilitated by intra-operative neuro-stimulation. In spite of these precautions, de novo urinary sequelae are observed in nearly 33% of patients and bladder evacuation disorders in 25% of patients. Advanced age, pre-operative urinary disorders, female gender, and abdomino-perineal resection are independent risk factors for urinary sequelae. Early post-operative urodynamic abnormalities might be predictive of these sequelae and justify early physiotherapy. Likewise, sexual sequelae such as erectile and/or ejaculatory disorders, dyspareunia and lubrication deficits result in de novo cessation of sexual activity in 28% of men and 18% of women. Advanced age, neo-adjuvant radiation therapy, and abdomino-perineal resection are independent risk factors for sexual dysfunction. Pharmacotherapy with sildenafil has proven useful in the treatment of erectile disorders. Genito-urinary and ano-rectal sequelae occur concomitantly in more than one of ten patients, suggesting a potential common pathophysiology.
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Affiliation(s)
- A Abdelli
- Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France
| | - X Tillou
- Service d'urologie et de transplantation rénale, CHU de Caen, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France
| | - A Alves
- Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France
| | - B Menahem
- Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France.
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