Postoperative urinary retention following transanal versus laparoscopic total mesorectal excision for rectal cancer: A randomized trial report from an experienced center

• Published in: Heliyon 2024-07, Vol.10 (14), p.e34753, Article e34753
• Main Authors: Ye, Fujin, Ruan, Lei, Liu, Zhanzhen, Xie, Hao, Wan, Taixuan, Zhu, Wenliang, Li, Ze, Xiao, Wei, Zheng, Haoqi, Lei, Dongxu, Zhou, Yebohao, Zheng, Xiaobin, Liang, Zhenxing, Liu, Huashan, Huang, Pinzhu, Kang, Liang, Huang, Liang
• Format: Article
• Language: English
• Subjects: Postoperative urinary retention; Rectal cancer; Transanal total mesorectal excision
• ISSN: 2405-8440; 2405-8440
• DOI: 10.1016/j.heliyon.2024.e34753

Transanal total mesorectal excision has emerged as a potential solution to certain limitations associated with laparoscopic total mesorectal excision in rectal cancer patients. Differences in surgical approaches have raised questions regarding their impact on the risk of postoperative urinary retention, with limited data available from large scale randomized clinical study. To report incidence of postoperative urinary retention and evaluate the associated risk factors for transanal total mesorectal excision. In this randomized controlled trial (ClinicalTrials. gov NCT06147492), we retrieved 524 patients who received total mesorectal excision (TME) for stage I–III rectal cancer between June 2019 and April 2022, and the patients were randomly assigned in a 1:1 ratio to undergo either taTME or laTME. We enrolled 524 patients who underwent total mesorectal excision for stage I–III rectal cancer between June 2019 and April 2022. The incidence of postoperative urinary retention. Among the 524 enrolled patients, 261 were randomized to the laTME group, while 263 were were randomized the taTME group. The median age was 58 years, and 340 participants (64.8 %) were male. Notably, 37 individuals (7.0 %) experienced postoperative urinary retention during the follow-up period, with no significant disparity was observed between the taTME and laTME groups (6.8 % and 7.2 %, respectively, P = 0.98). Risk factors associated with PUR in patients following taTME encompassed early removal of the urinary catheter (P = 0.006), net infusion rate >4.09 ml kg−1.h−1 (P = 0.006), and an age surpassing 65 years (P = 0.0321). The generalizability of the findings outside specialist rectal cancer centers may be limited. Transanal total mesorectal excision was not found to heighten the risk of postoperative urinary retention. Nonetheless, it is advisable removing postoperative catheter beyond the initial day and exercising caution in the administration of intravenous fluids in clinical practice for taTME procedures. •This study represents the first prospective cohort study in China to investigate PUR following taTME.•Clinical evidence suggests that taTME does not elevate the risk of PUR.•Clinical practice for taTME should adhere to the standard protocol of postponing postoperative catheter removal beyond the initial day.•The judicious administration of intravenous fluids with lower volumes is recommended for taTME procedures.