Annals of Coloproctology

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ERAS

Early urinary catheter removal in patients undergoing rectal cancer surgery: a randomized controlled trial on silodosin versus no pharmacological treatment on urinary function in the early postoperative period: Žilvinas Gricius, Justas Kuliavas, Eugenijus Stratilatovas, Bronius Buckus, Audrius Dulskas; Ann Coloproctol. 2025;41(3):239-245. Published online June 20, 2025; DOI: https://doi.org/10.3393/ac.2024.00703.0100

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Purpose
This study aimed to evaluate the efficacy of the α1 adrenergic receptor antagonist silodosin in preventing lower urinary tract symptoms after rectal cancer surgery.
Methods
We conducted a 2-arm, double-blind, single-center randomized controlled trial. The study included 150 patients with rectal cancer who underwent radical surgery between 2019 and 2022. On the first postoperative day, the urinary catheter was removed for all patients. Of these, 100 patients were administered silodosin, while 50 patients (control group) receive placebo (glucose tablet). Urinary dysfunction (urinary retention, infection, dysuria) and other complications were monitored.
Results
Among the 150 patients, 84 (56.0%) were male and 66 (44.0%) were female. Surgical procedures included abdominoperineal resection in 33 patients, partial mesorectal excision in 45, and total mesorectal excision in 72. A laparoscopic approach was used in 69 patients, while the remaining 81 underwent open surgery. Urinary tract symptoms developed in 10 patients (6.7%): 7 (7.0%) in the silodosin group and 3 (6.0%) in the control group (P=0.92). In the silodosin group, there was 1 case (1.0%) of urinary retention, 3 cases (3.0%) of urinary tract infection, and 3 cases (3.0%) of dysuria. In the control group, there was 1 case (2.0%) each of urinary retention, urinary tract infection, and dysuria (all P=0.92).
Conclusion
Early urinary catheter removal on the first postoperative day was safe in both groups. The use of the oral α-antagonist silodosin did not provide additional benefits in preventing lower urinary tract symptoms in patients undergoing rectal cancer surgery. Trial registration: ClinicalTrials.gov identifier: NCT03607370

Citations

Citations to this article as recorded by

Less is more: simplifying patient-centered cancer care
In Ja Park
Annals of Coloproctology.2025; 41(3): 173. CrossRef

Benign proctology,Postoperative outcome & ERAS,Complication

Predictors of postoperative urinary retention after semiclosed hemorrhoidectomy: Hong Yoon Jeong, Seok Gyu Song, Jong Kyun Lee; Ann Coloproctol. 2022;38(1):53-59. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00304.0043

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Abstract PDF

Purpose
This study was performed to analyze the predictors that might contribute to urinary retention following semiclosed hemorrhoidectomy under spinal anesthesia.
Methods
This retrospective study enrolled 2,176 consecutive patients with symptomatic grade III to IV hemorrhoids who underwent semiclosed hemorrhoidectomy between September 2018 and September 2019.
Results
Among the 2,176 patients, 1,878 (86.3%) had no postoperative urinary retention, whereas 298 (13.7%) developed urinary retention after hemorrhoidectomy. The percentage of males was significantly higher in the retention group than in the non-retention group (60.4% vs. 48.1%; P=0.001). The risk of urinary retention was 1.52-fold higher in males than in females (95% confidence interval [CI], 1.13–2.04; P=0.005), 1.62-fold higher in old age (95% CI, 1.14–2.28; P=0.006), and 1.37-fold higher with high body mass index (BMI) (95% CI, 1.04–1.81; P=0.025). Patients with ≥4 resected hemorrhoids had a higher odds ratio (OR) of 1.46 (95% CI, 1.12–1.89; P=0.005) than patients with <4 resected hemorrhoids. Among the supplementary medication, patients who used analgesics had a higher OR of 2.06 (95% CI, 1.57–2.68; P=0.001) than those who did not.
Conclusion
Male sex, age, high BMI, number of resected hemorrhoids, and supplementary analgesics are independent risk factors for urinary retention after semiclosed hemorrhoidectomy.

Citations

Citations to this article as recorded by

Real-world outcomes of hemorrhoidectomy with and without advanced energy devices: A propensity score-matched analysis from a tertiary center
I-Chun Huang, Hsin Hsu, Jayson Enn Ming Wong, Kun-Yu Tsai, Shu-Huan Huang
Current Problems in Surgery.2026; 77: 101981. CrossRef
The effect of methylene blue infiltrating injection on anal pain after Milligan–Morgan surgery: A randomized controlled clinical study
Jing Zhu, Heng Deng, Ming Li, Kun Tang
Medicine.2026; 105(7): e47613. CrossRef
Modern Mechanistic Interpretation of the “Homology of Liver and Kidney” Theory in Postoperative Urinary Retention after Anorectal Surgery
立洋秦
Asian Case Reports in Emergency Medicine.2026; 14(02): 180. CrossRef
Assessment of the efficacy and safety of pudendal nerve block in post-hemorrhoidectomy pain: A meta-analysis of randomized controlled trials
Jun Li, Hai-Qiong Wu, Jun-Tao Zhang, Shi-Jian Liu, Ke-Lin Peng
Asian Journal of Surgery.2025; 48(3): 1607. CrossRef
Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
Ice Packing Versus Warm Sitz Baths for Post-hemorrhoidectomy Pain Management: A Randomized Controlled Trial
Pin-Chun Chen, Yi-Kai Kao, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen
Diseases of the Colon & Rectum.2025; 68(7): 865. CrossRef
Defining the reliability of bladder scan in patients with obesity with postoperative urinary retention
Parit T. Mavani, Pranay S. Ajay, Heather B. Wagner, Benjamin I. Meyer, Monali Shah, Caitlin P. Sok, Adriana C. Gamboa, Subir Goyal, Jeffrey M. Switchenko, Shishir K. Maithel, David A. Kooby, Mihir M. Shah
Surgery.2025; 185: 109547. CrossRef
Spontaneous rupture of the urinary bladder following hemorrhoidectomy: A case report
Hanieh Raghimi, Rahim Jorjani, Sina Mohajernoei, Nasrollah Abian, Hossein Saffari, Ehsan Zolfi
International Journal of Surgery Case Reports.2025;[Epub] CrossRef
Hemorrhoidal Disease
Jean H. Ashburn
JAMA.2025; 334(17): 1541. CrossRef
Surgical outcomes of modified Ferguson hemorrhoidectomy for grade IV hemorrhoidal disease
Ahmet Cihangir Emral, Gökay Çetinkaya, Merter Gülen, Bahadır Ege
Anatolian Current Medical Journal.2025; 7(5): 652. CrossRef
Ultrasound-guided trans-perineal pudendal nerve block for post-hemorrhoidectomy voiding complications: a prospective randomized double-blinded study
Alrefaey K. Alrefaey, Shaimaa Ezzat Amin, Fahad S AL Amri
BMC Anesthesiology.2025;[Epub] CrossRef
Comparison of the effect of hot and cold compresses on post‐operative urinary retention in older patients: A clinical trial study
Tayebeh Mirzaei, Farkhondeh Roudbari, Ali Ravari, Sakineh Mirzaei, Elham Hassanshahi
International Journal of Urological Nursing.2024;[Epub] CrossRef
General anesthesia with local infiltration reduces urine retention rate and prolongs analgesic effect than spinal anesthesia for hemorrhoidectomy
Chun-Yu Lin, Yi-Chun Liu, Jun-Peng Chen, Pei-Hsuan Hsu, Szu-Ling Chang
Frontiers in Surgery.2024;[Epub] CrossRef
Effective non-surgical treatment of hemorrhoids with sclerosing foam and novel injection device
Juan Cabrera Garrido, Gonzalo López González
Gastroenterology & Endoscopy.2024; 2(4): 176. CrossRef
Effect of incision location and type of fistula on postoperative urinary retention after radical surgery for anal fistula: a retrospective analysis
Chen Li, Ningyuan Liu, Zichen Huang, Zijian Wei, Keyi Li, Wenxiao Hou, Sangyu Ye, Lihua Zheng
BMC Gastroenterology.2024;[Epub] CrossRef
Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review
Cosmin Moldovan, Elena Rusu, Daniel Cochior, Madalina Elena Toba, Horia Mocanu, Razvan Adam, Mirela Rimbu, Adrian Ghenea, Florin Savulescu, Daniela Godoroja, Florin Botea
World Journal of Clinical Cases.2023; 11(2): 366. CrossRef
Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients
Lei-lei Wang, Meng Kang, Li-xin Duan, Xu-fei Chang, Xiao-xin Li, Xiang-yang Guo, Zhi-yu Kang, Yong-zheng Han
Frontiers in Surgery.2023;[Epub] CrossRef
Efficacy of Low-Frequency Electroacupuncture on Urinary Retention After Spinal Anesthesia
Mina Olia, Aliakbar Jafarian, Masood Mohseni
Journal of PeriAnesthesia Nursing.2023; 38(5): 745. CrossRef
Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study
Amir F. Abdelhamid, Mohamed M. Elsheikh, Osama H. Abdraboh
The Egyptian Journal of Surgery.2023; 42(3): 669. CrossRef
Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report
Zhexuan Chen, Chuxi Lin
BMC Anesthesiology.2023;[Epub] CrossRef

Malignant disease, Functional outcomes,Colorectal cancer,Postoperative outcome & ERAS

Systematic Early Urinary Catheter Removal Integrated in the Full Enhanced Recovery After Surgery (ERAS) Protocol After Laparoscopic Mid to Lower Rectal Cancer Excision: A Feasibility Study: Hélène Meillat, Cloé Magallon, Clément Brun, Cécile de Chaisemartin, Laurence Moureau-Zabotto, Julien Bonnet, Marion Faucher, Bernard Lelong; Ann Coloproctol. 2021;37(4):204-211. Published online April 22, 2021; DOI: https://doi.org/10.3393/ac.2020.05.22

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17 Web of Science
14 Citations

Abstract PDF

Purpose
Enhanced Recovery After Surgery (ERAS) programs advocate early urinary catheter removal after rectal cancer surgery; however, the optimal duration remains unclear. This study assessed the feasibility of the early urinary catheter removal protocol after rectal cancer surgery within an ERAS pathway and identified predictive factors for failure of this strategy.
Methods
Between March 2017 and October 2018, all unselected and consecutive patients who underwent rectal cancer resection and benefited from our ERAS program were included. Urinary complications (infection and retention) were prospectively recorded. Success was defined as catheter removal on postoperative day (POD) 3 without urinary complications.
Results
Of 135 patients (male, 63.7%; neoadjuvant chemoradiation, 57.0%; urology history, 17.8%), 120 had early urinary catheter removal with no complications (success rate, 88.9%), 8 did not have urinary catheter removal on POD 3 due to clinical judgment or prescription error, 5 experienced a urinary tract infection, and 2 had acute urinary retention. Obesity (odds ratio [OR], 0.16; P = 0.003), American Society of Anesthesiologists physical status classification > II (OR, 0.28; P = 0.048), antiaggregant platelet medication (OR, 0.12; P < 0.001), absence of anastomosis (OR, 0.1; P = 0.003), and prolonged operative time (OR, 0.21; P = 0.020) were predictive factors for failure. Conversely, optimal compliance with the ERAS program (OR, 7.68; P < 0.001), postoperative nonsteroidal anti-inflammatory drug use (OR, 21.71; P < 0.001), and balanced intravenous fluid therapy (OR, 7.87; P = 0.001) were associated with increased strategy success.
Conclusion
Withdrawal of the urinary catheter on POD 3 was successfully achieved after laparoscopic rectal resection and can be safely implemented in the ERAS program.

Citations

Citations to this article as recorded by

Adherence to Evidence‐Based Guidelines and Implications When Designing Electronic Documentation for Urinary Catheters
Bothe Janine, Lagat Sheena, Rebecca Crellin, Kelly‐Ann Hahn, Patton Vicki
Journal of Clinical Nursing.2025; 34(7): 2737. CrossRef
Improving Perioperative Care in Gastric Surgery: Insights from the EUropean PErioperative MEdical Networking (EUPEMEN) Project
Orestis Ioannidis, Elissavet Anestiadou, Jose M. Ramirez, Nicolò Fabbri, Javier Martínez Ubieto, Carlo Vittorio Feo, Antonio Pesce, Kristyna Rosetzka, Antonio Arroyo, Petr Kocián, Luis Sánchez-Guillén, Ana Pascual Bellosta, Adam Whitley, Alejandro Bona En
Journal of Clinical Medicine.2025; 14(6): 2108. CrossRef
Less is more: simplifying patient-centered cancer care
In Ja Park
Annals of Coloproctology.2025; 41(3): 173. CrossRef
Enhanced rehabilitation after surgery: principles in the treatment of emergency complicated colorectal cancers – a narrative review
Alexandra-Ana Mihailescu, Sebastian Gradinaru, Alin Kraft, Corneliu-Dan Blendea, Bogdan-Sorin Capitanu, Stefan Ilie Neagu
Journal of Medicine and Life.2025; 18(3): 179. CrossRef
Immediate versus early urinary catheter removal after gastrectomy under enhanced recovery after surgery protocols: randomized clinical trial
Chen Wei, Gang Wang, Hai-Feng Wang, Hua-Feng Pan, Zhi-Wei Jiang, Mu-Wen Qu
BJS Open.2025;[Epub] CrossRef
Predicting venous thromboembolism and determining appropriate prophylaxis in elderly patients undergoing colorectal cancer surgery with Enhanced Recovery After Surgery (ERAS) using the adjusted Caprini score
Young Sun Choi, Hyung Jin Cho, Chul Seung Lee, Dong Geun Lee, Choon Sik Chung, Gwan Cheol Lee, Dong Woo Kang, Jeong Sub Kim, Tae Gyu Kim
Annals of Coloproctology.2025; 41(4): 279. CrossRef
Enhanced Recovery After Surgery (ERAS): Transforming Orthopedic Trauma Management
Ahmed Mohamed, Daniel Francis, Usman Fuad, Sagaurav Shrestha, Tamaraebi Itoko, Ioannis P Pengas
Cureus.2025;[Epub] CrossRef
Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Suprapubic versus transurethral catheterization for bladder drainage in male rectal cancer surgery (GRECCAR10), a randomized clinical trial
B. Trilling, F. Tidadini, Z. Lakkis, M. Jafari, A. Germain, E. Rullier, J. Lefevre, J. J. Tuech, A. Kartheuser, D. Leonard, M. Prudhomme, G. Piessen, J. M. Regimbeau, E. Cotte, D. Duprez, B. Badic, Y. Panis, M. Rivoire, B. Meunier, G. Portier, J. L. Bosso
Techniques in Coloproctology.2024;[Epub] CrossRef
Immediate urinary catheter removal after colorectal surgery with the enhanced recovery after surgery protocol
In Kyeong Kim, Chul Seung Lee, Jung Hoon Bae, Seung Rim Han, Do Sang Lee, In Kyu Lee, Yoon Suk Lee
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Predictors of urinary tract infection after lower gastrointestinal surgery
Gianluca Buzzi, Maria Antonello, Federico Scognamiglio, Ottavia De Simoni, Gaya Spolverato, Pierluigi Pilati, Salvatore Pucciarelli, Imerio Angriman, Marco Scarpa, Ignazio Castagliuolo
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
The feasibility and advantages of immediate removal of urinary catheter after lobectomy: A prospective randomized trial
Lei Zhang, Xueying Yang, Ye Tian, Qian Yu, Yang Xu, Di Zhou, Zhuo Wu, Xitong Zhao
Nursing Open.2021; 8(6): 2942. CrossRef

Morphine Spinal Block Anesthesia in Patients Who Undergo an Open Hemorrhoidectomy: A Prospective Analysis of Pain Control and Postoperative Complications: Hélio Moreira, José PT Moreira, Raniere R Isaac, Onofre Alves-Neto, Thiago AC Moreira, Tiago HM Vieira, Andressa MS Brasil; Ann Coloproctol. 2014;30(3):135-140. Published online June 23, 2014; DOI: https://doi.org/10.3393/ac.2014.30.3.135

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12 Web of Science
13 Citations

Abstract PDF

Purpose

This study evaluated the use of adding morphine to bupivacaine in spinal anesthesia for pain control in patients who underwent an open hemorrhoidectomy.

Methods

Forty patients were prospectively selected for an open hemorrhoidectomy at the same institution and were randomized into two groups of 20 patients each: group 1 had a spinal with 7 mg of heavy bupivacaine associated with 80 µg of morphine (0.2 mg/mL). Group 2 had a spinal with 7 mg of heavy bupivacaine associated with distilled water, achieving the same volume of spinal infusion as that of group 1. Both groups were prescribed the same pain control medicine during the postoperative period. Pain scores were evaluated at the anesthetic recovery room and at 3, 6, 12, and 24 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded.

Results

There were no anthropometric statistical differences between the two groups. Pain in the anesthetic recovery room and 3 hours after surgery was similar for both groups. However, pain was better controlled in group 1 at 6 and 12 hours after surgery. Although pain was better controlled for group 1 after 24 hours of surgery, the difference between the groups didn't achieved statistical significance. Complications were more common in group 1. Six patients (6/20) presented coetaneous pruritus and 3 with (3/20) urinary retention.

Conclusion

A hemorrhoidectomy under a spinal with morphine provides better pain control between 6 and 12 hours after surgery. However, postoperative complications, including cutaneous pruritus (30%) and urinary retention (15%), should be considered as a negative side of this procedure.

Citations

Citations to this article as recorded by

Pulmonary complications after intrathecal morphine administration: a systematic review and meta‐analysis with meta‐regression and trial sequential analysis
Kariem El‐Boghdadly, Yves Renard, Jean‐Benoit Rossel, Eleni Moka, Thomas Volk, Narinder Rawal, Cécile Jaques, Marta Szyszko, Eric Albrecht
Anaesthesia.2025; 80(8): 959. CrossRef
Intradermal methylene blue analgesic application in posthemorrhoidectomy pain management: a randomized controlled trial
Ramin Azhough, Pooya Jalali, Mohammad Reza Dashti, Sahar Taher, Ali Aghajani
Frontiers in Surgery.2024;[Epub] CrossRef
The effect of bupivacaine on analgesia and safety in patients undergoing hemorrhoidectomy: a meta-analysis
Haixia Lu, Min Cai, Dongxi Zhou, Weiwei Li, Hanzhong Cao
Frontiers in Pharmacology.2024;[Epub] CrossRef
Non-pulmonary complications of intrathecal morphine administration: a systematic review and meta-analysis with meta-regression
Yves Renard, Kariem El-Boghdadly, Jean-Benoît Rossel, Alexandre Nguyen, Cécile Jaques, Eric Albrecht
British Journal of Anaesthesia.2024; 133(4): 823. CrossRef
Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review
Cosmin Moldovan, Elena Rusu, Daniel Cochior, Madalina Elena Toba, Horia Mocanu, Razvan Adam, Mirela Rimbu, Adrian Ghenea, Florin Savulescu, Daniela Godoroja, Florin Botea
World Journal of Clinical Cases.2023; 11(2): 366. CrossRef
The Assessment of Marcaine Versus Meperidine for Spinal Anesthesia in Anorectal Surgery: A Randomized Clinical Trial
Mehran Rezvani Habibabadi, Masumeh Safaee, Ali Rezaei
Anesthesiology and Pain Medicine.2023;[Epub] CrossRef
Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review
Varut Lohsiriwat, Romyen Jitmungngan
Medicina.2022; 58(3): 418. CrossRef
Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease: a non-inferiority randomized controlled trial
Konstantinos Perivoliotis, Michail Spyridakis, Elias Zintzaras, Eleni Arnaoutoglou, Manousos-Georgios Pramateftakis, Konstantinos Tepetes
International Journal of Colorectal Disease.2021; 36(2): 353. CrossRef
The effect of adding morphine to intratecal bupivacaine on postoperative analgesia in patients with perianal surgery
Münire BABAYİĞİT
Anatolian Current Medical Journal.2021; 3(2): 124. CrossRef
Endogenous Opiates and Behavior: 2015
Richard J. Bodnar
Peptides.2017; 88: 126. CrossRef
Evidence‐Based Management of Pain After Excisional Haemorrhoidectomy Surgery: A PROSPECT Review Update
Tarik Sammour, Ahmed W. H. Barazanchi, Andrew G. Hill, Francis Bonnet, Barrie Fischer, Girish Joshi, Henrik Kehlet, Philipp Lirk, Narinder Rawal, Stephan Schug, Marc Van de Velde, Marcel Vercauteren
World Journal of Surgery.2017; 41(2): 603. CrossRef
Prolonged Opioid-Sparing Pain Control after Hemorrhoidectomy with Liposome Bupivacaine: Results from a Cohort of 95 Patients
Allen B. Jetmore, Douglas Hagen
Pain Studies and Treatment.2016; 04(01): 5. CrossRef
Spinal Block Anesthesia With Morphine in a Hemorrhoidectomy
Byung Chun Kim
Annals of Coloproctology.2014; 30(3): 107. CrossRef

Intraoperative Muscular Injection of Tarasyn(R) for Postoperative Hemorrhoidectomy Pain Management.: Kim, Kuhn Uk , Park, Weon Kap , Lee, Kwang Real , Yoo, Jung Jun , Lim, Seok Won , Kim, Hyun Shig , Lee, Jong Kyun; J Korean Soc Coloproctol. 1998;14(2):269-274.

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Abstract PDF: The pain after a hemorrhoidectomy is widely feared by many patients who are mostly still treated with oral/intramuscular narcotics to control their pain postoperatively. In an effort to decrease posthemorrhoidectomy pain by applying newer methods of analgesia, a prospective trial was conducted to investigate the postoperative analgesic effect of Tarasyn(R) (ketorolac tromethamine) injected into the internal sphincter muscle at the time of the hemorrhoidectomy. Tarasyn(R) is a nonsteroidal anti-inflammatory drug introduced for intramuscular injection to control postoperative pain. It's action is peripheral. Therefore, it seems appropriate to inject it directly into the anal sphincter muscles when these are exposed during anorectal procedures. A total loading dose of 60 mg(2 cc, 30 mg/ml) of ketorolac was used intraoperatively. It was injected intramuscularly locally after completion of hemorrhoidectomy. Postoperative pain after a hemorrhoidectomy can be safely controlled in a patient by using newer methods of pain control, including supplemental use of the nonsteroidal analgesic ketorolac, which allows early release of the patient, the day of surgery by diminishing the postoperative pain in our study group. Another important advantage of a local injection of ketorolac was the elimination of urinary retention.

Randomized Controlled Trials

The Effects of Pudendal Block in Voiding Complication after Anal Surgery.: Kim, Jae Hwang , Jang, Seon Mo , Shim, Min Chul , Jee, Dae lim; J Korean Soc Coloproctol. 2000;16(6):365-370.

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Abstract PDF: Urinary retention in common benign anal surgery is a burden to ambulatory surgery. PURPOSE: To reduce voiding complication pudendal nerve block (PB) was applied in hemorrhoids surgery.
METHODS
We compared PB with spinal anesthesia (SA) for anal surgery. In this prospective study, 163 patients undergoing elective hemorrhoids surgery by single surgeon were randomized to receive either PB with 0.5% bupivacaine (n=81) with 1: 20,000 epinephrine or SA with 0.5% bupivacaine (n=83).
RESULTS
There were no statistically significant differences in patient demographics, total amount of administered fluid, time to onset of block, or intraoperative pain. All patients had a successful block for surgery however, puborectalis muscle relaxation with PB was not complete. The time from injection of the anesthetics to first development of pain was longer in the patients who received PB (9.1 vs 3.1h; P<0.001). Urinary catheterization needed in only 6 patients in PB group compared with 57 cases in SA group (p<0.001). Degree of pain was significantly low in PB (2.7 vs 5.2 with VAS; p<0.001) Injected analgesics was significantly reduced in PB (16/81 vs 45/82; p<0.001) CONCLUSIONS: Our results suggest that PB with bupivacaine results in fewer postoperative voiding complications and less pain compared with traditional SA in hemorrhoidectomy.

A Prospective Study on the Relationship between Postoperative Urinary Retention and Amount of Infused Fluid during Surgery of Benign Anal Diseases under Spinal Anesthesia.: Lee, Chai Young , Kim, Hee Cheol , Lee, Dong Hee; J Korean Soc Coloproctol. 1999;15(5):357-361.

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Abstract PDF: PURPOSE
Urinary retention is a frequent postoperative complication after benign anorectal surgery. Factors, known to affect postoperative urinary retention, are age, sex, anesthetics, operative method, operative time and perioperative fluid injection. This study was performed to know whether the incidence of urinary retention might be controlled by reducing the amount of perioperative fluid.
METHODS
Eighty patients underwent surgery for hemorrhoids and chronic anal fissures were allocated into two groups, fluid restriction group (n=37) and hydration group (n=43). All patients were consecutively randomized from May 1998 to January 1999 and they were under 50 years old without urologic abnormality. Fluid was infused at 100 ml/h from the midnight then it's rate was changed into 10 ml/h for 4 hours from the beginning of the anesthesia for the restriction group, whereas 1000 ml/h only during operation for the hydration group. Thereafter it was changed into the same rate with 100 ml/h on both groups.
RESULTS
There was no significant differences with regard to age, sex, operation time, degree of pain and use of analgesics between two groups. Although there was a significant difference in the total volume of the infused fluid (Restriction group: 53.4 119.5 ml versus Hydration group: 778.6 319.0 ml, mean SD, p<0.001). Catheterization was done in 29 patients of the restriction group (78.4%) and 37 patients of the hydration group (86.0%), respectively. The frequency of catheterization was 1.3 0.7 times in the former and 1.6 0.7 times in the latter group.
CONCLUSIONS
A strict restriction of fluid infusion appeared to be unnecessary for the purpose of preventing the urinary retention during surgery of benign anorectal diseases with spinal anesthesia.

The Effects of Early Ambulation on Urinary Retention and.: Kim, Seon Hahn , Lee, Il Ok , Kim, Dong Hee; J Korean Soc Coloproctol. 1999;15(3):179-185.

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Abstract PDF: INTRODUCTION: Urinary retention (UR) is one most common complication of anal surgery and its cause is multifactorial. Postdural puncture headache (PDPH) is caused by cerebrospinal fluid leakage after spinal anesthesia, therefore it may be aggravated by early ambulation. PURPOSE: To determine whether early ambulation (EA) vs. bed rest (BR) reduces the incidence of UR after anal surgery under spinal anesthesia, without causing PDPH.
METHODS
In this prospective, randomized study, 107 patients undergoing anal surgery under spinal anesthesia were randomly assigned in the EA group (n=54) or the BR group (n=53). UR was defined as a voiding difficulty that needs catheterization. In the BR group, the patients were positioned flat in bed on the operation day. Anesthetic techniques (tetracaine injection using 24-gauge needle in sitting position, bupivacaine local infiltration) and postoperative pain therapy (intramuscular demerol injection every 6 hours, oral nonsteriodal antiinflammatory drug plus acetaminophen) were standardized. Perioperative intravenous fluids were restricted.
RESULTS
Urinary retention and PDPH occurred in 32 (29.9%) and 7 (6.5%) patients, respectively. UR was significantly reduced in the EA group (10/54=18.5%) vs. the BR group (22/53=41.5%) (p=0.017, Chi-square). The incidence of PDPH, however, was not different between the two groups (5.6% in the EA vs. 7.5% in the BR group).
CONCLUSIONS
Early ambulation has important implication on reducing the incidence of urinary retention after anal surgery under spinal anesthesia, without causing PDPH.

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