Introduction
Postoperative bladder dysfunction is a known complication after pelvic surgery. Urinary retention remains a barrier to discharge after abdominoperineal resections (APR), low anterior resection (LAR), and sigmoidectomy. This study aims to assess the impact of urinary retention on hospital length of stay and characterize risk factors associated with failure to void in the postoperative period.

Methods
Retrospective chart review was performed to identify patients undergoing sigmoidectomy, LAR, APR, or total proctocolectomy at one academic medical center between March 2015 and June 2020. Patients with colovesical fistulas, concurrent cystectomy or ureteral repair, and those undergoing HIPEC or pelvic exenteration were excluded. All patients were managed per institutional ERAS protocol. Patient demographics, operative characteristics, failure to void, straight catheterization, Foley re-insertion, discharge with Foley, postoperative UTI, history of BPH, history of pelvic radiation, and history of urologic surgery were extracted from the medical record. Primary outcomes included failure to void and length of stay. Univariable and multivariable analysis were performed to identify factors associated with failure to void.

Results
A total of 783 patients were identified. Seventy-one patients (9.1%) failed to void in the postoperative period, with Foley catheters replaced in 8.4%. Patients who failed to void had a significantly longer hospital length of stay (5 days vs 3 days, p < 0.001). In multivariable logistic regression, age greater than or equal to 60 (OR 1.73, 95% CI: 1.00-2.97, p=0.049), history of BPH (OR 2.25, 95% CI: 1.05-4.85, p=0.037) and APR (OR 2.82, 95% CI: 1.42-5.58, p=0.003) were independent risk factors for failure to void. There were no associations between failure to void and BMI, epidural use, history of pelvic radiation, prior urologic surgery, or use of neoadjuvant therapy (p>0.05). When stratified by gender, for male patients, age greater than or equal to 60 (OR: 3.21, 95% CI: 1.46-7.07, p=0.004) and lower BMI (OR: 0.91, 95% CI: 0.83-0.98, p=0.019) were associated with failure to void on multivariable analysis. For female patients, APR (OR 3.76, 95% CI: 1.30-10.91, p=0.015) was the only factor associated with higher risk of failure to void on univariable analysis.

Conclusions
Urinary retention after pelvic surgery is uncommon but contributes to longer length of hospitalization by two days. For higher risk patients, such as those who are older, with BPH and undergoing APR, early preoperative education on the potential need to discharge home with a Foley catheter should be considered. Further work should investigate the potential effect of prophylactic alpha-1 blockers on length of stay in the high-risk group.

Ronald Bleday

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