Urologic Issues in Colorectal Surgery

Introduction

Urologic issues pertaining to colorectal surgery can be broadly categorized according to the organ involved: the ureter, bladder, or urethra and their associated nerves and vessels. Because both colorectal surgeons and urologists have become more familiar with laparoscopic techniques, urologic issues encountered in colorectal surgery often may be addressed in a minimally invasive fashion without conversion to an open surgery. In this chapter we will discuss the common situations in which colorectal surgeons and urologists interact.

Infection

Perioperative urinary tract infections can be encountered after urethral catheterization and other instrumentation of the urinary tract. Both urinalysis (unless strongly positive) and irritative voiding symptoms soon after urethral catheter removal may be unreliable indicators of infection. However, if symptoms persist or other clinical signs of infection develop and are unrelated to the recent surgery, a urine sample should be collected in a sterile fashion and sent for culture. Empiric antibiotic coverage is started, using twice daily ciprofloxacin or trimethoprim-sulfamethoxazole. After the results of the urine culture are available, the antibiotics should be discontinued or changed, as appropriate.

A urinary tract infection may present outside the postoperative period. In this situation, a urinalysis may be more reliable. If a urinalysis suggests infection, a urine sample collected in a sterile fashion should be sent for culture. Treatment with the first-line agents mentioned previously should be pursued and tailored to the culture results unless prior microbiology data document resistance to such an agent. If infections are recurrent and the organism is the same, a urologic workup is required because the cause may be a foreign body (e.g., a suture or stone) or an anatomic abnormality (e.g., diverticulum). If recurrent infections with differing enteric organisms develop, a search for an enteric-urinary fistula should be considered.