Bladder Irrigation Should NOT Be Performed with Distilled Water
Sterile normal saline is the only recommended solution for bladder irrigation; distilled water should never be used due to the risk of fatal hemolysis and severe hyponatremia. 1
Why Distilled Water Is Dangerous
- Fatal hemolysis can occur when distilled water enters the bloodstream through exposed bladder vessels, particularly in patients with bladder ulcers, recent biopsies, or post-surgical bleeding 2
- A documented case report describes sudden death in a 45-year-old man who developed acute hyponatremia and massive intravascular hemolysis after bladder irrigation with sterile water through deep bladder ulcers that exposed veins 2
- The hypotonic nature of distilled water causes red blood cells to absorb water and rupture when the solution is absorbed systemically, leading to hemolysis and electrolyte disturbances 2
The Only Safe Solution: Sterile Normal Saline
- The American Urological Association and Infectious Diseases Society of America recommend sterile normal saline as the standard irrigation solution for continuous bladder irrigation through 3-way Foley catheters 1
- Room temperature or body temperature saline is preferred over cold water for patient comfort, though both temperatures are effective 1
When Bladder Irrigation Is Actually Indicated
- Active hematuria following urological procedures to prevent catheter obstruction from blood clots 1, 3
- Macroscopic hematuria with indwelling catheter requiring continuous bladder irrigation and possible endoscopic hemostasis if bleeding persists 4, 3
- Continue irrigation until visible hematuria resolves and urine output is clear 3
Critical Pitfalls to Avoid
- Never use distilled or sterile water for bladder irrigation in routine clinical practice due to hemolysis risk 2
- Do not routinely irrigate catheters to prevent infection, as bladder irrigation with normal saline does not reduce catheter-associated bacteriuria or UTI in patients with long-term catheterization 1, 5
- Do not add antimicrobials or antiseptics to drainage bags as routine practice, as this does not reduce infection risk 1
Special Context: Transurethral Surgery
While some older studies suggested sterile water might be safe during transurethral resection procedures with intact mucosa 6, 7, this does NOT apply to standard bladder irrigation scenarios where mucosal integrity may be compromised. The fatal case report demonstrates that even small areas of exposed vasculature can lead to catastrophic outcomes 2. In clinical practice outside of specialized surgical contexts, only sterile normal saline should be used.