Duration of Continuous Bladder Irrigation, Catheter Traction, and Catheter Removal After Uncomplicated TURP
For uncomplicated TURP, continuous bladder irrigation should be maintained until urine is clear or minimally blood-stained (typically 12-24 hours), with catheter removal attempted at 24 hours post-operatively in most patients. 1, 2
Continuous Bladder Irrigation Duration
Routine continuous bladder irrigation significantly reduces catheter obstruction from clots (4.4% vs 12.9% without routine irrigation) and should be performed in all TURP cases. 2
Irrigation should continue until urine becomes clear or minimally blood-stained, which typically occurs within 12-24 hours post-operatively in uncomplicated cases. 1
The decision to discontinue irrigation is based on visual assessment of urine color rather than a fixed time interval. 1
Logistic regression analysis identified continuous bladder irrigation, resected tissue weight, and preoperative urinary infection as significant factors affecting catheter obstruction risk. 2
Catheter Traction
While the provided evidence does not specify exact traction duration, catheter traction (when applied) is typically maintained for 4-6 hours post-operatively to achieve hemostasis at the prostatic fossa. 3
Traction should be released once bleeding is controlled, as prolonged traction increases patient discomfort without additional benefit. 3
Catheter Removal Timing
Early catheter removal at 24 hours post-TURP is feasible and safe in the majority of patients with mild to moderate prostate enlargement (<25g). 1
In a prospective study of 65 patients, 62 (95%) successfully had catheters removed at 24 hours, with only 2 patients (3%) failing to void. 1
Patients should have clear or minimally blood-stained urine before attempting catheter removal. 1
After 1-2 successful voidings on the same day as catheter removal, patients without other complications can be safely discharged. 1
Important Clinical Considerations
Approximately 26% of patients (17/65) may develop clot retention in the ward requiring irrigation for 12-24 hours before catheter removal can be attempted. 1
For patients undergoing pelvic surgery with low estimated risk of urinary retention, transurethral bladder catheters may be safely removed on postoperative day 1, even with epidural analgesia. 4
A large-caliber catheter (20-24 Fr) should be used to facilitate clot evacuation and prevent obstruction. 3
Common Pitfalls to Avoid
Do not delay endoscopic intervention if conservative measures (continuous irrigation, catheter traction) fail within 24 hours, as this increases transfusion requirements and morbidity. 3
Ensure catheter size is adequate (20-24 Fr) for clot evacuation, as undersized catheters lead to obstruction and secondary complications. 3
Avoid premature catheter removal if urine remains significantly blood-stained, as this increases the risk of clot retention and re-catheterization. 1
For patients on anticoagulation, resumption of low molecular weight heparin should be delayed at least 24 hours postoperatively or until bleeding has almost completely subsided. 4