Abstract
Background
Postoperative urinary retention remains an important concern following total mesorectal excision (TME), resulting in relatively conservative urinary catheter management despite advances in robotic surgery and enhanced recovery after surgery (ERAS) pathways. We evaluated the feasibility of immediate urinary catheter removal before extubation within a structured integrated perioperative pathway incorporating perioperative tamsulosin.Methods
A prospective single-centre service evaluation cohort study was conducted between October 2024 and October 2025. Forty-eight consecutive patients undergoing robotic TME for rectal cancer were managed according to a predefined integrated perioperative pathway. All procedures were performed using the da Vinci Xi robotic platform. Tamsulosin 0.4 mg once daily was administered for three days before surgery and three postoperative days. Urinary catheters were removed immediately before extubation. The primary endpoint was successful immediate urinary catheter removal before extubation without the subsequent need for postoperative urinary recatheterisation. Successful immediate urinary catheter removal was defined as spontaneous postoperative voiding without the need for urinary recatheterisation. Failure of the pathway was defined as clinically significant postoperative urinary retention requiring temporary urinary recatheterisation within 72 h after surgery. Secondary outcomes included urinary tract infection, major postoperative morbidity, early mobilisation, readmission and length of stay.Results
Mean age was 61 years and 31 patients (64.6%) were male. Thirty-eight patients (80%) received neoadjuvant treatment, 33 (68.8%) underwent surgery for ultra-low rectal cancer and 40 (83.3%) received a protective ileostomy. Successful immediate urinary catheter removal before extubation without postoperative urinary recatheterisation was achieved in 46 of 48 patients (95.8%). Two patients (4.2%) required temporary urinary recatheterisation because of clinically significant postoperative urinary retention. Recatheterisation occurred in two patients (4.2%; exact 95% confidence interval 0.5-14.3%), both with longstanding benign prostatic hyperplasia receiving chronic medical therapy. No postoperative urinary tract infections, anastomotic leaks, major postoperative complications, readmissions or mortality were observed. Early mobilisation within 24 h was achieved in 45 patients (93.7%), and median postoperative hospital stay was two days.Conclusion
Immediate urinary catheter removal before extubation was feasible in this prospective service evaluation cohort managed within a predefined integrated perioperative pathway. These findings support further prospective comparative evaluation but should not be interpreted as evidence of superiority over conventional catheter management. The concentration of recatheterisation events amongst patients with pre-existing benign prostatic hyperplasia supports further investigation of individualised postoperative urinary management.