Bladder Irrigation: Understanding the Procedure and Its Benefits

Three main indications: post-TURP or post-prostatectomy for clot prevention in the first 24-48 hours, gross hematuria with clot retention regardless of cause, and after bladder tumour resection. A 3-way Foley catheter (22-24 Fr) with normal saline is standard. Isotonic 0.9% NaCl is preferred over sterile water — sterile water absorbed through open prostatic sinusoids can cause dilutional hyponatremia (TURP syndrome). Start flow at 100-200 mL/h and titrate to keep outflow pale pink, not red.

Four signs demand immediate action: inflow continues but outflow stops or slows dramatically; suprapubic distention or pain; bladder spasms; and outflow suddenly turns bright red or contains clots. Stop the inflow, perform a manual bladder washout with a 60 mL bladder syringe (30-60 mL saline aliquots, aspirate back), and if resistance persists escalate to the urologist. Never force the syringe — you can rupture the bladder. Document input and output volumes hourly; a discrepancy of >200 mL over 2 hours is a red flag.

Five: (1) catheter-associated UTI (CAUTI) — insist on strict aseptic bag changes; (2) hyponatremia from fluid absorption — check serum sodium daily if CBI runs beyond 24 hours; (3) bladder spasm — belladonna & opium (B&O) suppositories or oxybutynin help; (4) urethral trauma from catheter migration — secure the catheter to the thigh; (5) fluid overload in patients with cardiac or renal comorbidity — track input-output balance every 4 hours and weigh daily.

Standard weaning: once outflow is consistently clear or pale straw-coloured for 12-24 hours after post-operative CBI, reduce flow rate stepwise, then stop irrigation and continue passive drainage for another 12-24 hours. Remove the 3-way catheter and replace with a 2-way if the patient needs ongoing drainage, or perform a trial of void. Document post-void residual with bladder scan before catheter-free discharge.