PURPOSE: Bladder drainage allows monitoring of urine output, intraoperative decompression of the bladder, and prevention of postoperative urinary retention. Commonly, bladder drainage is by transurethral cathterization, which is associated with a high incidence of bacteriuria, pain, discomfort, urethritis, abscess, and stricture. Suprapubic bladder drainage has been frequently reported to be superior to urethral drainage because of less urinary infections, less pain and discomfort, no urethritis, and easier care. We have prospectively compared the outcomes following suprapubic catheterization (SPC) with those following transurethral catheterization (TUC) in patients undergoing colorectal surgery. METHODS: A prospective randomized trial of SPC versus TUC was undertaken in 40 patients (M:F=26:14) undergoing colorectal surgery from April 2003 to December 2003. Twenty patients were catheterized through the urethra using a 16F Foley catheter. In the other twenty patients, an identical catheter was placed in the bladder through the suprapubic abdominal wall. Significant bacteriuria was defined as > or =10(5) organisms/ml. The pain and discomfort of patients were obtained by using a questionnaire. RESULTS: There were no difference in the incidence of complications between the SPC and the TUC. The number of patients with pain and discomfort was significantly greater and more severer for TUC, especially in males. According to operation type, abdominoperineal resection had the longest duration of catheterization. CONCLUSIONS: This study suggests that the use of SPC rather than TUC significantly reduces pain and discomfort of patients undergoing colorectal surgery.