Study design
This study was designed as a prospective study at the department surgery of Tehran University Hospital from 2019 to 2021. After obtaining medical ethical committee approval (IR.TUMS.MEDICINE.REC.1398.235), patients with rectal cancer who underwent low anterior resection (LAR) or abdominoperineal resection (APR) surgery between April 2019 and December 2021 were included. Informed consent was taken from all patients.
Eligibility criteria included: Patients ≥18 years old with rectal cancer who underwent LAR or APR, which confirmed by pathology with international prostate symptoms score (IPSS) <7.
IPSS is a reliable measure that developed by world health organization (WHO). It consists of seven question with scores ranging 0 to 35. IPSS scores are usually classified to three groups: mild (0-7), moderate (8-18), and high scores (19-35) [14]. It is noted that patients have been assessed in two groups (IPSS≤7 vs IPSS>7) in this study.
Exclusion criteria were as followed: 1) Patients with age less than 18 years old; 2) Patients with history of chronic heart failure (CHF), chronic kidney disease (CKD), benign prostate hyperplasia (BPH), diabetes mellitus (DM), cirrhosis, and coronary artery disease (CAD); 3) Previous history of urologic surgery or other pelvic surgery; 4) Urinary incontinence; 5) If needed post-operative intake/output chart; 6) Sensitivity to tamsulosin; 7) Active urinary tract infection (UTI).
postoperative management
The surgical procedure was performed by the expert surgeon and his team. Patients were randomly divided into two groups (postoperative tamsulosin treatment; intervention group) and (without postoperative tamsulosin; control group). In intervention group, patients be administrated tamsulosin 0.4mg preoperative (14 hours and 2 hours before surgery) and postoperative until patient is discharged orally.
Data collection and follow-up
Demographic, clinical, and para-clinical data included age, gender, associated comorbidity, type of surgery, IPSS, and rating of POUR.
In total, 60 patients with rectal cancer who had undergone LAR or APR, followed by tamsulosin in intervention group were included in this study. All patients received enhanced recovery after surgery (ERAS) protocol postoperative, including: early out of bed, and if needed using non-opioid analgesic. Foley catheter was removed on post-operative day two (POD2) in all patients, then were assessed for POUR by surgeon.