Early Post-operative Removal of Urethral Catheter in Patients Undergoing Colorectal Surgery With Epidural Analgesia
Early Post-operative Removal of Urethral Catheter in Patients Undergoing Colorectal Surgery With Epidural Analgesia
Patients undergoing colon or rectal surgery will usually have a urinary catheter (silicone
 tube) placed in the bladder at the time of operating to monitor kidney function during
 surgery and in the post-surgery period. Such patients will also have an infusion into the
 spine, known as an epidural, after surgery to provide them with continuous pain relief.
 Urinary catheters should be removed as early as possible once they are no longer required to
 facilitate patients becoming mobile after surgery and to reduce the risk of patients
 developing a urinary tract infection.

 Traditionally these catheters are not removed until the patients epidural infusion is
 withdrawn, as in theory to do so would predispose the patient to developing acute retention
 of urine due to lack of sensation when the bladder is full. The investigators hypothesis is
 that urinary catheters placed via the urethra can be withdrawn 48 hours after colon/rectal
 surgery in patients receiving epidural pain relief without a significant increase in rates of
 urinary retention.
Patients undergoing colon or rectal surgery will be randomly assigned to one of two groups:
 Patients in study group 1 (SG1) will have their urinary catheters removed at 48 hours
 post-operatively; Patients in study group 2 (SG2) will have their urinary catheters removed
 only after the epidural has been withdrawn in the post-operative period. We will be primarily
 examining rates of urinary retention in both groups. We will also be examining rates of
 urinary tract infection, chest infection (frequently a result of poor mobility after
 surgery), and wound infection and other complications after surgery.
Inclusion Criteria:

 -  Age > 18

 -  Competent to consent to participate in trial

 -  Undergoing colorectal surgery (any resection of large bowel, formation of colostomy,
 anterior resection, low anterior resection, panproctocolectomy, abdominoperineal
 resection).

 -  Receiving epidural analgesia post-operatively

 -  If male, international prostate symptom score <20.

 Exclusion Criteria:

 -  Previous lower urinary tract surgery

 -  Chronic lower urinary tract disease

 -  Intermittent self-catheterisation

 -  Neurogenic bladder

 -  Urethral catheter inserted >24 hours pre-operatively

 -  Presence of pelvic sepsis/abscess at surgery

 -  Previous trans-abdominal pelvic surgery

 -  Urethral catheter required for urine output monitoring beyond 24 hours
 post-operatively

 -  Presence of enterovesical fistula

 -  Pre-operative use of medications which alter detrusor function

 -  Pregnancy