From the Guidelines
Urological flush therapy should be performed using a sterile saline solution, with a standard regimen of 50-100 mL instilled into the bladder via a catheter, allowed to remain for 15-20 minutes, then drained, and repeated 2-3 times daily for 3-5 days, as recommended by the most recent guidelines 1.
Key Considerations
- The goal of urological flush therapy is to cleanse the bladder and urinary tract of debris, blood clots, or bacteria, reducing the risk of infection and promoting healing.
- The use of antibiotic solutions, such as gentamicin or neomycin-polymyxin, may be considered for persistent infections, but should be guided by antimicrobial stewardship principles to combat the rising threat of antimicrobial resistance 1.
- In cases of bladder hemorrhage, a 1% alum solution may be used to control bleeding.
- Patients should maintain adequate hydration (2-3 liters daily) during treatment to help flush the urinary system naturally.
- For home administration, strict aseptic technique is essential to prevent introducing new infections.
Potential Side Effects
- Bladder spasms
- Discomfort during instillation
- Rarely, systemic absorption of medications used in the solution
Guiding Principles
- The European Association of Urology guidelines on urological infections emphasize the importance of a thorough medical history and physical examination, as well as antimicrobial stewardship 1.
- The guidelines provide recommendations for antibiotic selection, dosing, and duration based on the latest evidence 1.
- The use of urological flush therapy should be individualized based on the patient's specific clinical needs and medical history.
From the Research
Urological Flush Therapy
- Urological flush therapy, also known as intravesical gentamicin instillation, is a treatment used to prevent and treat urinary tract infections (UTIs) in patients with complex urological cases 2, 3, 4, 5.
- The treatment involves instilling gentamicin, an antibiotic, directly into the bladder via a catheter, and has been shown to be effective in reducing the frequency of UTIs in patients with recurrent infections 2, 3, 4, 5.
- The safety of gentamicin bladder irrigations has been assessed in several studies, and no significant adverse events or systemic absorption of gentamicin have been reported 2, 3, 4, 5.
- The treatment has been used in patients with various types of urinary tract abnormalities, including those requiring clean intermittent catheterization, and has been shown to be well-tolerated and effective in reducing UTI episodes 2, 3, 4, 5.
Effectiveness of Urological Flush Therapy
- Studies have shown that intravesical gentamicin instillation can reduce the number of UTI episodes in patients with recurrent infections, with success rates ranging from 58% to 86% 3, 4, 5.
- The treatment has also been shown to reduce the degree of antimicrobial resistance in uropathogens, with one study reporting a decrease in resistance rate from 78% to 23% 4.
- The use of intravesical gentamicin has been evaluated in patients with multidrug-resistant bacteria, and has been shown to be effective in reducing UTI episodes and improving outcomes 4.
Comparison with Other Treatments
- One study compared the use of chlorhexidine versus saline for meatal cleaning prior to urinary catheter insertion, and found that chlorhexidine was more effective in reducing catheter-associated UTIs and was cost-effective 6.
- However, this study did not evaluate the use of intravesical gentamicin instillation, and further research is needed to compare the effectiveness and safety of different treatments for preventing and treating UTIs in patients with complex urological cases.