Early Removal of Urinary Catheters in Patients After Rectal Surgery: a Prospective Study
Early Removal of Urinary Catheters in Patients After Rectal Surgery: a Prospective Study
Recent national surgical quality guidelines (Surgical Care Improvement Project, National
 Hospital Inpatient Quality Measures)state that removal of urinary catheters should occur by
 post-operative day two for all surgical patients. These guidelines exclude neither patients
 who have undergone rectal surgery nor those with epidural analgesic catheters. The common
 practice among most colorectal surgeons is to leave urinary catheters in for three to five
 days for patients who have undergone rectal operations, due to concern for urinary retention.
 This study aims to explore the outcomes of following the national surgical guidelines for
 early urinary catheter removal, especially with regards to urinary retention and urinary
 tract infection.
All patients undergoing anterior resection (rectosigmoid), low anterior resection,
 abdomino-perineal resection, total proctocolectomy with ileal pouch-anal anastomosis, sigmoid
 colectomy, and coloanal anastomosis will be included in the study. All patients will undergo
 standard pre-operative work-up prior to the operation. As part of the operative note, the
 level of the anastomosis must be documented.

 1. All patients will have foley catheters removed between 0600 and midnight of
 post-operative day 3 (Day 0 being the day of operation).

 2. All patients will undergo bladder ultrasound prior to catheter removal.

 3. All patients will undergo bladder ultrasound by nursing staff six hours after catheter
 removal, and after voiding the first time after catheter removal, or if the patient
 experiences symptoms of urinary retention.

 6. Patients who meet definition of urinary retention (>100cc post-void residual) will undergo
 intermittent straight catheterization every six hours or with symptoms. For those who refuse
 intermittent straight catheterization, a indwelling urinary catheter will be inserted and
 left in for 24 hours before removal.

 7. For patients who have low urine output indicating under-resuscitation, indwelling
 catheters will be re-inserted and removed when ongoing resuscitation measures are completed.

 8. For patients who are actively undergoing fluid resuscitation on post-operative day 3 will
 not have their urinary catheters removed until resuscitation and monitoring is complete.

 9. Patients who report symptoms of benign prostatic hypertrophy (BPH) and/or are already on
 medications for BPH will be continued on those medications starting on post-operative day 1.

 10. Patients who have persistent urinary retention when they are otherwise ready to be
 discharged home will be sent home with a leg bag and follow up in urology clinic for voiding
 trial in 1-2 weeks.

 11. Urinalysis/urine culture will be performed for symptomatic patients.
Inclusion criteria

 All patients at Stanford Hospital undergoing:

 -  anterior resection

 -  sigmoid colectomy

 -  low anterior resection

 -  abdomino-perineal resection

 -  total proctocolectomy with ileal pouch-analanastomosis

 -  coloanalanastomosis.

 Exclusion criteria Patients with history of neurogenic bladder who had indwelling catheters
 or required intermittent straight catheterization prior to surgery