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What Causes Urinary Retention After Surgery For Rectal Cancer?

Posted on Wed, 26 Mar 2014

Question: AFTER BOWEL CANCER SURGERY CAN THE NERVES CUT DURING SURGERY REPAIR THEMSELVES AS THEY HAVE RESULTED IN A CATHETER BEING INSERTED BECAUSE THE BLADDER IS NOT WORKING EFFICIENTLY AND IS SUPPOSEDLY LAYING AT THE BACK SOMEWHERE. THE LEFT SIDE OF THE BOWEL WAS REMOVED. ALSO IF THE BOWEL TISSUE IS EXTREMELY FRAGILE AND A TEMPORARY COLOSTOMY HAS BEEN GIVEN IN THE HOPE OF REJOINING THE BOWEL. IS THERE ANY CHANCE THESE TSSUES CAN REPAIR THEMSELVES SUFFICIENTLY TO ALLOW REJOINING. PLEASE GIVE ME AN HONEST ANSWER.. the patient is a male of 70 years..SURGERY WAS PERFORMED ON 18.2.14

Answered by Dr. Krishna Kiran Kannepalli (22 minutes later)

Brief Answer: yes they can Detailed Answer: Hi. Thanks for the query. Urinary retention is a common problem after surgery for rectal cancer. This is due to division of the hypogastric nerves as might have happened in your case. The usual course of action in such cases is to leave the catheter in place for a few weeks and then give a voiding trial again. If the problem persists then urodynamic studies are performed to know the severity of the problem. Medications such as cholinergic agents help in recovery. The ultimate recovery depends on many factors. Most important is the patient's age and diabetes history. Young patients recover faster. Diabetics have a lesser chance of recovery. Some 10-20% of patients will require long term catherisation or intermittent self cathetisation.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Krishna Kiran Kannepalli (19 hours later)

THANK YOU DOCTOR FOR YOUR PROMPT REPLY. YOU HAVE GIVEN US A LITTLE MORE HOPE FOR THE FUTURE. MY FURTHER QUESTION IS GIVEN THAT THIS SITUATION WAS CAUSED BY A VERY NARROW PELVIS MAKING A DIFFICULT REMOVAL OF THE NECESSARY BOWEL AND ABOUT 18 LYMPH GLANDS OF WHICH 8 WERE CANCEROUS. LOTS OF NERVES WERE INCISED OVER THE 71/2 HOUR OPERATION. IF A PERMANENT CATHETER IS PUT IN WOULD THIS CAUSE ANY FURTHER NERVE DAMAGE RESULTING IN A POORER OUTCOME OF RECOVERY IN THE LONG TERM. WOULD SELF CATHETERISATION SEVERAL TIMES A DAY CREATE UTETHRA DAMAGE. WHICH WOULD BE THE BETTER PATH TO TRAVEL GIVEN THIS DILEMA. CHEMOTHERAPY IS YET TO BEGIN. I AGAIN THANK YOU FOR YOUR VALUED HELP AND AWAIT YOUR FURTHER REPLY.

Answered by Dr. Krishna Kiran Kannepalli (1 hour later)

Brief Answer: Better to go slow Detailed Answer: Hi. Thanks for the query. The catheter is put into the bladder in order to keep it empty and avoid infection. It is too early to try anything else now. The priority now is chemotherapy and radiation, which can be started 3-4 weeks after the surgery depending on the recovery. Before starting it, one trial of voiding can be given. In case it fails, better to leave the patient on a catheter until completion of adjuvant treatment and then try again. Intermittent catheterisation is a last resort when other measures fail. Soft catheters are available and they don't damage the urethra.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar