Retrospective risk analysis for acute urinary dysfunction after laparoscopic rectal cancer surgery in patients receiving
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ORIGINAL ARTICLE
Retrospective risk analysis for acute urinary dysfunction after laparoscopic rectal cancer surgery in patients receiving epidural analgesia Masatsugu Hiraki 1
&
Toshiya Tanaka 1 & Eiji Sadashima 2 & Hirofumi Sato 1 & Kenji Kitahara 1
Accepted: 8 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Urinary dysfunction (UD) is a frequent complication following rectal surgery. The aim of the present study was to investigate the risk factors for acute UD after laparoscopic low anterior resection (LALAR) for rectal cancer in patients receiving epidural analgesia. Methods A retrospective study was conducted on 131 patients who underwent LALAR among those receiving epidural analgesia in a single institution between October 2008 and December 2019. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with acute UD. Results The overall incidence of acute UD was 16.0% (21/131). Univariate analysis showed that older age (P = 0.016) and earlier urinary catheter removal (P = 0.036) were associated with acute UD. Multivariate logistic regression analysis revealed that older age (10-year increments; odds ratio (OR) 2.046, 95% confidence interval (CI) 1.171–3.543, P = 0.011), urinary catheter removal before epidural analgesia discontinuation (OR 6.393, 95% CI 1.540–26.534, P = 0.011), and a large tumor circumference rate (10% increments; OR 1.263, 95% CI 1.043–1.530, P = 0.017) were independent risk factors for acute UD. Conclusion Our findings suggest that older age, early removal of urinal catheter before epidural analgesia discontinuation, and large tumor circumference rate are risk factors of acute UD after LALAR for rectal cancer in patients receiving epidural analgesia. Keywords Urinary dysfunction . Laparoscopic surgery . Rectal cancer . Low anterior resection . Epidural analgesia
Introduction Laparoscopic surgery for rectal cancer has expanded throughout the world. The benefits of the laparoscopic procedure have been reported to include a high degree of magnification and excellent visual access, reduced amounts of intraoperative blood loss, an early postoperative recovery, a shorter hospital stay, and better cosmetic results [1, 2]. However, urinary dysfunction (UD) after laparoscopic low anterior resection (LALAR) is still a frequent complication.
* Masatsugu Hiraki [email protected] 1
Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga 849-8571, Japan
2
Life Science Research Institution, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga 849-8571, Japan
UD is considered to be caused mainly by autonomic nerve injury related to the patient, tumor, and surgical factors [3–7]. Total mesorectal excision (TME) for rectal cancer is required to ensure the achievement of safe plane dissection from the tumor and to avoid nerve damage. Damage to the hypogastric nerves may result in urinary incontinence [3]. Damage to the sacral splanchnic ne
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