Effect of ICCAUT Strategy on Postoperative Urinary Retention After Radical Rectal Cancer Surgery (ICCAUT-2)

The First Hospital of Jilin University

Overview

The objective of this trial is to investigate the effect of bladder training on the incidence of re-catheterization after proctectomy. In this study, the bladder training include intermittent urethral catheter clamping combined with active urination training, which we called ICCAUT strategy. This prospective, single-center, randomized controlled trial will enroll patients with rectal cancer who will be randomized in a 1:1 ratio to the ICCAUT group or the free-drainage group. In the ICCAUT group, patients will undergo intermittent clamping of the urinary catheter before its removal. Each time the catheter is released, we will encourage the patients to actively initiate urination to facilitate complete bladder emptying. While patients in the free-drainage group will not undergo any specific training. The urinary catheter will be removed on the second postoperative day for both groups. The primary endpoint is the incidence of re-catheterization due to urinary retention. Secondary endpoints include urinary tract infection (UTI), time of first urination after catheter removal, residual urine volume after the first urination, postoperative morbidity and mortality within 30 days, as well as urinary function within 30 postoperative days.

Urinary catheter placement is a standard procedure before proctectomy. However, the necessity of bladder training prior to catheter removal remains uncertain. The objective of this trial is to investigate the effect of bladder training on the incidence of re-catheterization after proctectomy. In this study, the bladder training include intermittent urethral catheter clamping combined with active urination training, which we called ICCAUT strategy. This prospective, single-center, randomized controlled trial will enroll patients with rectal cancer who will be randomized in a 1:1 ratio to the ICCAUT group or the free-drainage group. In the ICCAUT group, patients will undergo intermittent clamping of the urinary catheter before its removal. Each time the catheter is released, we will encourage the patients to actively initiate urination to facilitate complete bladder emptying. While patients in the free-drainage group will not undergo any specific training. The urinary catheter will be removed on the second postoperative day for both groups. The primary endpoint is the incidence of re-catheterization due to urinary retention. Secondary endpoints include urinary tract infection (UTI), time of first urination after catheter removal, residual urine volume after the first urination, postoperative morbidity and mortality within 30 days, as well as urinary function within 30 postoperative days.

Study Type

Interventions

ICCAUTPROCEDURE

In this study ,the ICCAUT strategy include intermittent catheter clamping and active urination training. For patients in the ICCAUT group, intermittent catheter clamping will be initiated at 9:00 AM. The catheter will be clamped for 3 h, followed by a 5-minute release, which is one cycle. The next cycle will begin after the cycle was completed. Catheter training is to conclude at 10:00 PM on the first postoperative day, and the catheter is left open during the night. At 6:00 AM on the second postoperative day, another cycle of catheter training will be performed, with the catheter removed at 9:00 AM. During the training period, if the patient experiences a strong urge to urinate before the 3-hour clamping time is over, the clamping can be released in advance for 5 min, allowing the patient to proceed to the next cycle of bladder training. Each time the catheter is released, we will encourage the patients to actively initiate urination to facilitate complete bladder emptying.

Free drainagePROCEDURE

For patients in the free draining group, no intervention will be performed on the catheter during this period. The catheter will be removed at 9:00 AM on postoperative day two.

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: 1. Patients with a confirmed preoperative diagnosis of rectal cancer. 2. Patients with tumors located below the rectosigmoid junction, as determined by preoperative computed tomography (CT) or rectal magnetic resonance imaging (MRI). 3. Patients undergoing laparoscopic or robotic-assisted total mesorectal excision (TME) for rectal cancer. Exclusion Criteria: 1. History of abdominal surgery involving the rectum, sigmoid colon, left hemicolectomy, bladder resection or partial resection, prostate surgery, or hysterectomy. 2. History of urethral injury, cranial surgery, spinal surgery, stroke with limb dysfunction, or Parkinson's disease. 3. Inability to urinate through the urethra preoperatively due to various reasons (e.g., ureteral puncture or ureterostomy). 4. Presence of urinary tract infection preoperatively. 5. Previously diagnosed with bladder overactivity syndrome, urinary retention or voiding dysfunction, or diabetic bladder disease. 6. Concomitant resection of other pelvic organs was performed during surgery, including the bladder, prostate, uterus, cervix, and vagina, except for simple adnexal resection. 7. Lateral lymph node dissection for rectal cancer. 8. Injury to the ureter, bladder, or urethra during the perioperative period. 9. Preoperative renal dysfunction (serum creatinine level \>133 μmol/L). 10. Emergency surgery. 11. Male patients with preoperative benign prostatic hyperplasia receiving medication treatment. 12. Patients with a ureteral stent or ureteral stricture, or bilateral hydronephrosis. 13. Conversion to open surgery. Withdrawal Criteria: After randomization, patients will be withdrawn from the trial if the following situations occur: 1. Inability to remove the urinary catheter within 5 days postoperatively due to various reasons (e.g., impaired consciousness, transfer to the intensive care unit (ICU), Sequential Organ Failure Assessment (SOFA) score ≥2, etc.). 2. Secondary catheterization was performed after catheter removal for reasons other than urinary retention (e.g., secondary surgery, shock, rectal bladder leakage, ureteral leakage, or urethral injury). 3. Patient requests to withdraw from the study at any time during the entire study process. 4. Selective α1-adrenergic receptor blocker is used during the first catheterization of the patient due to medical necessity.

Outcomes

Primary Outcomes

secondary catheterization owing to urinary retention

The primary endpoint of this study is the rate of secondary catheterization owing to urinary retention until discharge. Secondary catheterization can be performed by urethral catheter insertion or suprapubic puncture. The decision to perform secondary catheterization is based on the specific criteria determined by the clinician.

Time frame: within 7 days after the first time of urethral catheter removal

Secondary Outcomes

Urinary tract infections

A urinary tract infection is characterized by an inflammatory response in the urinary tract epithelium resulting from bacterial invasion. To diagnose a urinary tract infection, the following criteria must be met simultaneously: 1) urinalysis indicating a bacterial count above the upper limit of normal and 2) positive urine culture.

Time frame: within 1 days after the first time of urethral catheter removal

The time to first voiding after catheter removal

The time to first voiding after catheter removal refers to the duration, measured in hours, from the moment the catheter was removed until the patient spontaneously voids for the first time.

Time frame: within 1 days after the first time of urethral catheter removal

The residual urine volume after the first voiding

The residual urine volume after the first voiding is determined by assessing the volume of urine remaining in the bladder immediately after the patient's initial voiding following catheter removal using bladder ultrasonography.

Time frame: within 1 days after the first time of urethral catheter removal

Graded assessment of catheter-related bladder discomfort (CRBD)

CRBD is a questionnaire given to the patients, to investigate the severity of the discomfort of patients to the urinary catheter

Time frame: within 1 days after the first time of urethral catheter removal

Voiding function

Voiding function is evaluated by International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and International Prostate Symptom Score (IPSS).

Time frame: on the second day after the first time of urethral catheter removal, and at the 30th day after surgery

Postoperative complications

Complications that occur within 30 days after the operation will be evaluated and documented according to the Clavien-Dindo classification (19). Complications of grade II or higher were analyzed.

Time frame: within 30 days after the operation

Effect of ICCAUT Strategy on Postoperative Urinary Retention After Radical Rectal Cancer Surgery (ICCAUT-2)

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes