What is the recommended duration for traction and continuous bladder irrigation (CBI) in a patient with a trip-related injury?

Duration of Traction and Continuous Bladder Irrigation for TURP

For post-TURP continuous bladder irrigation (CBI), maintain catheter drainage for 2-3 weeks as standard practice, with CBI discontinued once effluent clears (typically 24-48 hours postoperatively). 1

Catheter Duration After TURP

• Standard catheter drainage should be maintained for 2-3 weeks following bladder injury or TURP procedures 1
• In patients with significant concurrent injuries, extending catheter duration beyond 3 weeks is acceptable 1
• Consider open repair only if bladder injuries remain non-healing after 4 weeks of catheter drainage 1

CBI Duration and Management

• CBI should be titrated based on effluent color and discontinued when output clears, typically within 24-48 hours post-procedure 2, 3
• Average irrigation speed ranges from 0 to 86.7 mL/min, with mean of 9.46 mL/min, adjusted to maintain light pink to clear effluent 3
• Urine drainage bags require emptying approximately every 2.2 hours during active CBI 3

Catheter Type Recommendation

• Use urethral catheter drainage alone (14-16 Fr) without routine suprapubic cystostomy 1, 4
• Suprapubic catheterization is reserved only for patients with associated perineal injuries or those requiring long-term catheterization 1
• Combined suprapubic and urethral catheterization shows no advantage and results in longer hospital stays and higher morbidity 1

Follow-Up Imaging

• Perform follow-up cystography to confirm healing after 2-3 weeks of catheter drainage 1
• CT scan with delayed phase imaging is the preferred method for documenting bladder injury resolution 1
• Complex repairs require mandatory follow-up imaging, while simple repairs may not necessitate routine cystography 1

Common Pitfalls to Avoid

• Never use IV pumps for CBI in specialized settings (e.g., hyperbaric chambers) due to risk of iatrogenic bladder rupture; use gravity-fed systems only 5
• Avoid premature catheter removal before confirming injury healing, as this can lead to urinary extravasation and complications 1
• Do not routinely place suprapubic tubes, as this increases morbidity without benefit 1
• Monitor for clot retention during CBI, which occurs in approximately 15% of cases and requires irrigation rate adjustment 3

Clinical Monitoring During CBI

• Medical personnel should assess CBI function 1-11 times per shift depending on bleeding severity 3
• Patients experience significant mobility restriction (average 10.5% time out of bed) during CBI 3
• Pain levels are typically low (mean 0.60/10) but correlate with general impairment when present 3