From the Guidelines
For a comatose patient with a full bladder who was planned for TURP, the next step at the time of operation would be to place a Foley's catheter (option A). This is the most appropriate immediate intervention to relieve urinary retention and decompress the bladder safely. The Foley catheter should be inserted gently using aseptic technique with adequate lubrication, typically using a 16-18 Fr size catheter with a 30 mL balloon. The catheter allows for immediate bladder decompression, monitoring of urine output, and provides a route for bladder irrigation if needed. This approach is preferred because it's less invasive than a suprapubic catheter and provides reliable drainage. Key considerations in this scenario include:
- Relieving bladder distension to prevent complications like bladder rupture, renal impairment, or autonomic dysreflexia
- Monitoring urine output to assess renal function
- Addressing the cause of the comatose state before proceeding with any elective surgery like TURP, as the patient's altered consciousness represents a contraindication to elective procedures, as noted in guidelines for managing patients with urinary retention 1. The patient's comatose state takes precedence over the planned TURP, and thus, the primary focus should be on stabilizing the patient and managing the acute issue of urinary retention.
From the Research
Patient Assessment and Catheterization
- The patient is comatose with a full bladder and is planned for Transurethral Resection of the Prostate (TURP) 2, 3.
- The first step in managing this patient would be to assess the need for urinary catheterization to relieve the full bladder and prevent further complications.
Catheterization Options
- There are several options for catheterization, including:
- Foley's catheter (indwelling urethral catheter)
- Suprapubic catheter
- Indwelling catheter
- The choice of catheterization method depends on various factors, including the patient's medical condition, the presence of any urethral injuries or strictures, and the anticipated duration of catheterization 4, 5.
Recommendations
- For a patient with acute urinary retention, such as the one described, a transurethral catheter (Foley's catheter) is often the first line of treatment, unless there is a contraindication such as a urethral injury or stricture 5.
- If a transurethral catheter is not feasible, a suprapubic catheter may be considered as an alternative option 4, 3.
- An indwelling catheter is a broader term that encompasses both transurethral and suprapubic catheters, and the choice between these two options would depend on the specific clinical circumstances 2, 6.
Clinical Considerations
- The patient's comatose state and full bladder require prompt attention to prevent further complications, such as urinary tract infections or kidney damage 3.
- The choice of catheterization method should be guided by the patient's individual needs and medical condition, as well as the potential risks and benefits associated with each option 4, 6.