From the Research
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 decompress the bladder safely, as it provides the quickest and least invasive method to relieve urinary retention 1. A Foley catheter is a flexible tube that can be inserted through the urethra into the bladder to drain urine. In this emergency situation, the catheter should be inserted gently using aseptic technique and appropriate lubrication, with a size 16-18 Fr typically being adequate. Once inserted, the balloon should be inflated with 5-10 ml of sterile water to secure its position. The immediate drainage of urine will help prevent bladder overdistension, potential bladder rupture, and renal damage from back pressure.
The patient's comatose state represents a medical emergency that needs to be addressed before proceeding with any elective surgery like TURP. The TURP procedure should be postponed until the patient's neurological status is evaluated and stabilized. While suprapubic catheters may have some benefits, such as improved patient comfort and decreased bacteriuria, they are not the most appropriate initial choice in this emergency situation 2, 3. The most recent and highest quality study on urinary catheter management emphasizes the importance of proper catheter placement and maintenance to minimize complications 1.
Key considerations in this scenario include:
- The need for immediate bladder decompression to prevent complications
- The importance of aseptic technique and proper catheter placement
- The need to postpone elective surgery until the patient's medical emergency is addressed
- The potential benefits and drawbacks of different types of catheters, including Foley and suprapubic catheters 4, 5.