Bladder Irrigation Post Transurethral Resection

of the Prostate
11/10/2011

Author
Victoria Le B.SC

Summary

Question
What is the best available evidence regarding continuous bladder irrigation, post
transurethral resection of the prostate?

Clinical Bottom Line

Continuous bladder irrigation (CBI) is the continuous flushing and draining of the bladder
designed to prevent the formation and retention of blood clots following transurethral
resection of the prostate (TURP).1

Closed catheter irrigation with either continuous-flow or intermittent irrigation can be used,
with a suggested flow rate of 500 ml/hr for continuous-flow irrigation.2 (Level IV)
Normal saline solution elevated in 2000 ml bags should be used, not glycine or sterile
water, with flow rate adjusted according to the degree of hematuria. If no complications have
arisen the flow rate can be reduced or the catheter removed on the first or second day
postoperatively.2,3 (Level IV)
Two bags of Normal saline solution at different height could be used to prevent catheter
blockage by clots due to delay in replacing empty bag, particularly at night.4 (Level IV)
Signs of catheter blockage include: severe continuous bladder spasms, leakage of urine
around the catheter, adherence of blood clots or shreds of tissue in the lumen of the tubing,
if the patient complains of the urge to defecate, if the outflow drainage does not equal the
inflow irrigation rate or if the patient becomes distended (suprapubic distension). 1,2 (Level
IV)
If catheter blockage is suspected, the bladder irrigation should be stopped and an
assessment made of the degree of blockage. Where the blockage appears to be minimal,
milking the catheter tubing is recommended with observation of the drainage fluid for colour
and consistency. 1 (Level IV)
Other methods to prevent or relieve blockage is by injecting liquid solutions into the
catheter, this is known as washout. A recent review has tried to assess the effectiveness of
this method but no evidence has been found to suggest that washouts were helpful. But this
was based on small and poor quality studies, therefore more research is needed.(Level II)5
Hand irrigation using a Toomey syringe may be indicated when clots prove difficult to
remove. Hand irrigation should be continued until no further clots are evident. 2 (Level IV)

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 On occasion deflation of the catheter balloon is required in order to evacuate remaining
clots. Once all clots have been removed the catheter balloon can be re-inflated and irrigation
should be continued at a flow rate sufficient to keep the irrigation fluid clear or pale pink in
colour. The patient may require analgesia prior to this procedure. 2 (Level IV)
Recommended steps for assessing a blocked catheter include, check the saline irrigation
for remaining fluid, height of the elevation stand and the level of fluid in the drip container;
the drainage bag should be checked for amount, colour and consistency, whilst the tubing
should be assessed for patency, kinking, traction and leakage. Fluid balance/bladder
washout charts should be observed for inconsistency of fluid balance, indicating retention. If
fluid retention is suspected, percuss and/or palpate the patients bladder and ascertain the
patients level of discomfort. Consideration should also be given to the size of the catheter
and whether there is a history of catheter blockage.1 (Level IV)
A new improved delivery system for bladder irrigation has been devised which uses readily
available components and the novel modification of a sphygmomanometer blub. To increase
the flow rate of the irrigant system, the blub was inserted at the top of the irrigant bag. In
results of the study stated that this has better visualization during endourologic procedure
and prevents clot formation after open prostatectomy, TURP, and TURB without any
adverse effects. 6 (Level III)

Characteristics of the Evidence

This summary is based on a structured search of the literature and selected evidence-based
health care databases. The Evidence included in this summary is from:

An observational study1
Expert opinion2,3,4
A review consisting of randomized and quasi-randomized trials5
A journal article that conducted experiments to test the novel method6

Best Practice Recommendations

The patient under going continuous bladder irrigation should have their irrigation drainage
frequently checked for haematuria with colour and consistency. (Grade B)
Two bags of irrigation solution at different height could be used, particularly at night to
prevent delay replacement of empty bag. (Grade B)
All patients with bladder irrigation should have fluid input and output documented on a fluid
balance/bladder irrigation chart. (Grade B)
Normal saline is recommended over glycine or water as the irrigation solution of choice
postoperatively.(Grade B)
Patients receiving bladder irrigation should be monitored for signs of suprapubic distension
or discomfort indicating fluid retention. (Grade B)
Irrigation equipment should be assessed as a first line when blockage is suspected.(Grade

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B)
Patients who suffer moderate or severe gross hematuria due to various causes should
consider the improved delivery system which uses the novel modification of a
sphygmomanometer blub. (Grade B)

References
Ng C. Assessment and intervention knowledge of nurses in managing catheter patency in
continuous bladder irrigation following TURP. Uro Nurs.2001;21(2): 97-98. 110-111. (Level
IV)
Leslie S. Transurethral Resection of the Prostate.2006. www.eMedicine Transurethral
Resection of the Prostate: Treatment. Article by Stephen W Leslie.(Level IV)
Weaver J. Combating complications of transurethral surgery. Nursing. 2001. 31(7):33.
(Level IV)
Bugeja S, Mercieca M, German K. Additional application in bladder irrigation after TURP or
TURBT. Ann R Coll Surg Engl. 2009; 91(8); 720. (Level IV)
HagenS , Sinclair L, Cross S. Washout policies in long-term indwelling urinary
catheterisation in adults. Cochrane Database Syst Rev. 2010 (3); 1-36(Level II)
Moslemi MK, Rajaei M. An improved delivery system for bladder irrigation. Ther Clin Risk
Manag. 2010; 6: 459462(Level III)

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