Duration of Bladder Irrigation After TURP
Bladder irrigation after classic TURP should be discontinued when urine is clear or minimally blood-stained, typically within 24 hours, with catheter removal attempted at that time in uncomplicated cases.
Immediate Post-Operative Period (0-24 Hours)
- Continuous bladder irrigation should be maintained until urine clears, which typically occurs within the first 24 hours in most patients undergoing TURP for mild to moderate prostatic enlargement 1
- A large-caliber urethral catheter (20-24 Fr) should be placed to facilitate adequate drainage and prevent clot retention 2
- Irrigation can be maintained through diuretics given at operation or short-term saline irrigation in the operating theater 1
- Crystalloid administration should be maintained at 1-4 ml/kg/hr during the procedure, with goal-directed fluid boluses for patients developing intravascular volume deficits 3
Criteria for Discontinuing Irrigation
- Irrigation should be stopped when urine becomes clear or minimally blood-stained, allowing for catheter removal trial at 24 hours 1
- In a prospective study of 65 patients, 62 patients (95%) who had clear or minimally blood-stained urine successfully voided after catheter removal at 24 hours, with only 2 failures 1
- Approximately 17-26% of patients may develop clot retention requiring irrigation for 12-24 hours before attempting catheter removal 1
Extended Irrigation Requirements
- Patients who develop clot retention should receive bladder irrigation for 12-24 hours until urine clears before attempting catheter removal 1
- Regular monitoring of vital signs, urine output, and fluid balance is essential during the procedure and immediate post-operative period 3
- Avoid excessive fluid administration to prevent fluid overload and pulmonary edema, especially in patients with cardiac or renal comorbidities 3
Post-Catheter Removal Management
- Patients should maintain high fluid intake for 3 weeks after TURP, as gross hematuria typically ceases in 47% at 1 week, 73% at 2 weeks, and 96% at 3 weeks 4
- The duration of postoperative bleeding is directly related to the weight of tissue resected and operation duration 4
- Patients who continue to bleed beyond 3 weeks should be advised to continue high-fluid intake until urine is completely clear 4
Important Caveats
- Early catheter removal (24 hours) is feasible for mild to moderate prostatic enlargement (<25g) without significantly increasing complications 1
- Patients can be discharged after 1-2 successful voidings on the same day of catheter removal in uncomplicated cases 1
- The choice of irrigation fluid (glycine vs. sterile distilled water) does not significantly affect the frequency of postoperative complications like UTI or dilutional hyponatremia 5
- Bipolar TURP has a more favorable perioperative safety profile than monopolar TURP, partly due to different irrigation fluid requirements and lower absorption risks 3