Continuous Bladder Irrigation After Prostate Surgery

Continuous bladder irrigation may seem one of those scary medical names, especially if you feel nervous about your upcoming surgery. They say a tube will remain in your urethra, and name blood clots and complications. But when you understand what this procedure is, you can calm down.

It could be a bit annoying, but it is not a dangerous or painful process. When you know what happens and how to get better, you can empower yourself to be an active part in your recovery.

Continuous bladder irrigation is sometimes a required step after prostate surgery. It can also be used after bladder surgery, as in bladder tumor surgery. That’s why we have dedicated a special article to describing it and clearing doubts.

What is bladder irrigation, and why is it used?

The name continuous bladder irrigation or CBI can be broken down in three. Irrigation is the name doctors give to a flow of liquid. As a procedure, it consists of pouring water or a running liquid.

It is sometimes a saline solution but can be a solution with antibiotics during surgery. We say CBI is continuous because the flow of pouring liquid is not interrupted. And the organ that is being irrigated or infused with water is the bladder. Hence the B in CBI.

Putting everything together, CBI is the continuous infusion of irrigation solutions into the urinary bladder. This organ holds urine and has a continuous flow by itself. But after surgery, there is sometimes bleeding in the urinary tract. If we don’t accelerate the continuous irrigation flow with additional liquids, we could get blood clots. Moreover, CBI can also help patients urinate and prevent post-surgical complications.

With continuous bladder irrigation, your doctors are flushing out blood clots. In your bladder, they would aggregate and become a more significant clot. In time, they would cause obstruction or urination problems.

Additionally, CBI helps patients get rid of microscopic calculi. These bladder stones may also aggregate and create big masses of minerals. But that problem is quickly dissolved by continuous bladder irrigation (1).

In some cases, CBI is not recommended because you’re bleeding or creating bladder stones. It can be because your bladder is severely inflamed and irritated. You may have a urinary tract infection. If that’s the case, doctors may require to administer medicine directly to the bladder via CBI.

As you can see, multiple causes would make your doctor consider CBI. If you’re not sure what is happening in your case, feel free to ask. It can be either to prevent clot retention and bladder stone formation, to relieve inflammation, administer medications, or a combination of the above reasons (2).

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What will happen during continuous bladder irrigation?

Traditional Bladder Irrigation uses a Foley catheter, which will be placed in the urinary bladder. The catheter used in CBI is a special type called triple-lumen catheter.

Triple-lumen means that the portion that stays out of the urethra divides into three. So, it has one entry that stays inside the bladder, and on the outside, it is quickly divided into three parts. Each one of these ports has a different use, as you will see (3).

  • One of the ports or lumens is meant to drain your urine. Through this lumen, you will be emptying your bladder into another recipient outside of your body.

  • The second port or lumen has a direct connection with a small catheter balloon at the tip. After placing the indwelling catheter, the balloon is inflated. That way, the catheter can stay in place and become fixed without causing any harm.

  • The third port or lumen is used to irrigate or pour liquid. This is how you will get your bladder filled with a continuous flow of liquid. As mentioned above, this liquid can be a normal saline solution. It may also contain antibiotics and other medications.

After placing and fixing the catheter in place, it will be connected to an irrigation flask. This is a special type of equipment that looks like a bag full of liquid. This is usually sterile saline, but other medications can be added as well. Initially, the flask is hung on a pole. Then, the doctor or nurse will clean the irrigation lumen and attach the tubing.

Next up, the doctor or nurse will attach a drainage bag to the second lumen. This bag will initially look flat, but it will be slowly filling with urine and saline.

At first, the irrigation flask will be connected, but not passing any liquid. But before that happens, your doctor will make sure everything is doing fine. After checking that the urine drains without a problem, your healthcare provider will unclamp the tube that comes from the irrigation flask.

After placing it, you may need to empty your drainage every once in a while. When you do, the nurse will examine the urine in the drainage bag. After reviewing and measuring the amount of urine, it will get attached to the lumen once again.

You may notice that the irrigation flask is connected to one of the lumens. The other lumen is connected to the drainage bag outside of your body. And the third stays untouched until your doctor decides to remove the catheter.

There will be a continuous flow of liquid into the bladder from the irrigation flask. And the bag connected to the second lumen will be automatically filling.

During the process of CBI, your healthcare provider will constantly be checking on you. He will pay special attention to the urine that’s being collected in the drainage bag.

The color of the urine is essential because it may reveal the presence of blood (hematuria). The urine output is also important to monitor your kidney function. And it is also important to note if there are blood clots or bladder stones in the bag (4,5).

What should I expect after continuous bladder irrigation?

After you’re set-up and the procedure is done, you will be under CBI for a couple of days. You might feel discomfort, especially during the initial stage of the process.

The first urine you see in the drainage bag will probably be reddish or pink. It may also have visible blood clots. Do not feel afraid if that’s the case, because it is entirely normal during the initial stage. Actually, it means that CBI is working as it should and flushing them out.

You will be instructed about your current health, so be sure to ask any questions. If you’re not yet conscious or awake, your family will be instructed in your place. You may also need bladder scans and other evaluations to make sure everything is fine.

As time goes by, you will see how the drainage fills with clearer urine. It may start out darker, then pink, and finally completely clear. It is normal if your healthcare provider empties the drainage back very frequently. And then, when you get 24 hours or two days with clear or pinkish urine, CBI will be stopped.

During this process, it is advisable to tell your doctor or nurse anything you’re feeling. For example, report if you feel pain or discomfort in your bladder. If you see a urine leak, report that as well. During this process, you may experience these problems, which your doctor will probably do (4,5):

  • Not enough drainage: If your catheter is draining less than the irrigation, your doctor may stop CBI. After making sure the tubing is not looped or kinked, you will get a bladder exam. The flow rate will be recalculated, or you may need to clear an obstruction with manual irrigation. This is a simple procedure where your healthcare provider uses saline to flush the obstruction.

  • More blood or blood clots than expected: During the initial stage, it might be normal. But if you start seeing an increase in bloody drainage, your doctor may increase the irrigation rate. You might also need manual irrigation to clear the catheter from blood clots.

  • Abdominal or pelvic pain: There’s a chance you will feel pelvic pain during this procedure. Pain and discomfort should be evaluated. It may be due to the distension of the bladder. Another option is a bladder spasm. This is more common in cold environments, or if the irrigation solution is cold.

  • Confusion or agitation: Some patients may become agitated or confused after surgery. In these cases, doctors will discuss the case. It is maybe an irrigation fluid overload or a medication that’s behind the symptoms. In any case, the problem will likely be solved shortly.

  • Urine leaks: You can report urine leaks if you see liquid running around the catheter. There are two causes of urine leaks: bladder spasms and catheter obstruction. Thus, your doctor will assess your fluid balance and make a decision. It will be either using antispasmodic medications or a manual irrigation procedure.

Continuous irrigation of the bladder after prostatectomy

Prostatectomy is one of the most common surgical procedures performed in the prostate. It can be suprapubic prostatectomy or transurethral resection. It is a common procedure in cases of prostate cancer and benign prostatic hyperplasia.

You might need CBI in this case and other surgical procedures concerning the prostate. Remember that the male prostate is located in the bladder neck. By accessing to the prostate, other surrounding tissues will likely be affected. This is the prostatic fossa.

The manipulation of the prostate may also cause mild tearing in the bladder. Thus, continuous irrigation of the bladder is recommended in many cases. It is actually considered a routine post-operative procedure for some doctors. Still, if your doctor does not consider CBI necessary, he may have valid reasons, too (6).

We mentioned above the reasons why we typically advocate CBI after prostate surgery. In the case of prostatectomy, patients will already have a catheter placed after surgery. An additional reason in this particular case is to avoid collapsing the lumen of the catheter. 

But if your doctor decided not to perform continuous irrigation, here’s a list of possible reasons (6):

  • Hemostasis, or bleeding control: This is usually the main reason. Nowadays, we have more control over bleeding during surgery. Current technologies allow for bloodless surgery and almost complete bleeding control. Sometimes not even transfusions are necessary. In cases with no significant bleeding or tearing, CBI might not be required.

  • Reduced risk of bladder perforation: Not using CBI reduces the fluid input to the bladder. In the case of a catheter blockage, not using CBI gives healthcare staff more time to find and fix the problem. CBI has a higher risk of bladder rupture because of fluid retention increases in a shorter time.

  • Reduced discomfort for the patient: There’s a chance that CBI patients feel more discomfort and pain. Suprapubic pain is more common in patients with CBI. Without this procedure, patients may also reduce the time in confinement. Moreover, not using CBI reduces financial costs to the patient. It is also easier to handle urine output and reduces the workload on the staff.

For all of the above, your doctor may or may not consider CBI in your case. If he does not use CBI, it is probably because your surgery had some bleeding. But if you’re a candidate for CBI, rest assured it is for your sake.

Also, remember it is not a scary or dangerous procedure. You will be closely monitored to prevent any problem or adverse event. You will also have communication with nurses to report pain or any other distressing symptom.

Tips for better recovery after prostatectomy

If you’re recovering from prostatectomy, remember that you need to rest after surgery. Resting is one of the most important recommendations. For 6 weeks, you should take it easy and let your body recover. Here are recommendations we can give you (7):

  • Avoid driving for the first week or more time depending on recommendations

  • During the first weeks of recovery, get help for your household chores and meals

  • Do not pull, push or lift anything that weighs 10 pounds or more for 3 weeks

  • Avoid strenuous exercise for at least 4 weeks

  • Report severe or sharp pain right away

  • Follow recommendations if you’re instructed to take prescription medications. One of the most common is an antibiotic.

  • Avoid drinking alcohol regardless of the medications you’re taking. Alcohol can irritate your urinary bladder.

  • Look for a donut cushion and use it for the first weeks after surgery. This will reduce pressure in the pelvic region when you’re sitting.

  • Make your next appointment with your doctor 10 days after surgery.

Additionally, we recommend the following during your recovery period:

  • The evening after surgery: Rotate your feet from left to right. Bend your feet and wiggle your toes. Repeat 4 times these movements and then stretch your legs.

  • Day 1 after surgery: Try to avoid staying in bed for more than 90 minutes unless instructed by your doctor. Walk the hallways and use help if you need it.

  • Surgical site home care: Avoid baths until the urinary catheter is removed. You can take showers without a problem. Check the surgical site for hardness, warmness, redness, or foul-smelling drainage. Apply ice if you experience discomfort in the area of the scrotum.

  • Report any warning sign: Besides severe pain, other warning signs include dark red urine, large clots, high fever, diarrhea, nausea, vomiting. You can also go to the ER if your catheter is pulled out, or you have several hours without urine draining.

  • Prevent constipation: During the recovery time, it is important to have a regular bowel movement. To avoid constipation, drink more water, exercise, and eat more fiber. Vegetables, whole grains, fruits, prunes, and bran are good sources of fiber. You can also have stool softeners, but these should be prescribed by your doctor.

Conclusion

Continuous Bladder Irrigation is a post-surgical procedure to prevent complications. It is typically performed after prostate or bladder surgery. The aim of CBI is to flush out blood clots and to prevent bladder stones. It can be used to administer medications or relieve inflammation, too.

The procedure is very easy, but you will require constant monitoring by your healthcare provider. In any case, there’s no reason to feel alarmed if your doctor does not consider CBI necessary. Some patients may not be candidates or may not require this procedure.

Sources

  1. Han, M., & Partin, A. W. (2012). Retrograde and suprapubic open prostatectomy. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell–Walsh Urology. Philadelphia: Saunders Elsevier, 2695-2703.
  2. Byrne, J. E. (1952). Continuous bladder irrigation following prostatectomy. Medical bulletin. St. Louis University, 4(4), 77.
  3. Kinder, C. H. (1966). A simple irrigating catheter. British journal of urology, 38(3), 323-323.
  4. Végh, A., & Magasi, P. (1988). The importance of closed bladder irrigation in prostatectomy. Acta chirurgica Hungarica, 29(2), 137-141.
  5. Livne, P. M., & PM, L. (1982). Simple method of continuous bladder irrigation for prevention of postprostatectomy complications.
  6. Okorie, C. O. (2015). Is continuous bladder irrigation after prostate surgery still needed?. World Journal of Clinical Urology, 4(3), 108-114.
  7. Burt, J., Caelli, K., Moore, K., & Anderson, M. (2005). Radical prostatectomy: men’s experiences and postoperative needs. Journal of clinical nursing, 14(7), 883-890
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Dr Alberto Parra

Dr. Alberto Parra is a Medical Doctor and clinical researcher with extensive experience in diagnostic imaging and sports medicine. He's also interested in nutrition, fitness and family medicine, with expertise and continuing education on preventive healthcare and evidence-based medicine. He provides consultancy services to a number of individuals and entities who require medical validation of their protocols, products, supplements, and medical contents.

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