Lower Incidence of Postoperative Urinary Retention in Robotic Total Mesorectal Excision for Low Rectal Cancer Compared with Laparoscopic Surgery

The incidence and clinical significance of postoperative urinary retention remain high. This study aimed to evaluate the incidence of postoperative urinary retention and related risk factors in patients who underwent total mesorectal excision for low rectal cancer.This study is a retrospective review of a prospectively collected colorectal database from a single center. Data from patients who underwent surgery for low rectal cancer between September 2006 and May 2017 were analyzed to assess the risk factors of postoperative urinary retention. Postoperative urinary retention was considered inability to void after urinary catheter removal requiring catheter reinsertion and difficulty in bladder emptying requiring intermittent catheterization.Of 555 patients with low rectal cancer, 78 (14.1%) developed postoperative urinary retention. Based on multivariate logistic regression analysis, laparoscopic total mesorectal excision (OR; 2.114, 95% CI; 1.212-3.689, p = 0.008) and postoperative ileus (OR; 2.389, 95% CI; 1.282-4.450, p = 0.006) were independent risk factors of postoperative urinary retention. Male gender, advanced age, neoadjuvant chemoradiation, longer operative time, abdominoperineal resection, and lateral pelvic lymph node dissection were not associated with postoperative urinary retention. Advanced age over 65 years also failed to show statistical significance (OR; 1.604, 95% CI; 0.965- 2.668, p = 0.068).Laparoscopic approach and postoperative ileus are risk factors for postoperative urinary retention after low rectal cancer surgery. We postulate that the benefits of robotic surgical systems compared to a laparoscopic approach may reduce the incidence of postoperative urinary retention.