Post-Operative Care

Hematuria Management

• Hematuria that persists despite adequate continuous bladder irrigation (CBI) may require further evaluation to identify the bleeding source, as recommended by the American Urological Association 1
• The primary indication for CBI is management of hematuria following urological procedures such as transurethral resection of the prostate (TURP), open prostatectomy, and cystectomy, with equipment requirements including a three-way Foley catheter (22-24Fr) and sterile normal saline solution (0.9% sodium chloride) or Ringer's lactate as an alternative 1
• The irrigation setup should include the bag positioned 80-100 cm above bladder level, with the drainage bag below patient level, and an initial flow rate of 30-50 ml per hour, titrated based on effluent color and bleeding severity, as recommended by the European Association of Urology 1
• For severe hematuria, irrigation frequency should be every 4-6 hours, with 30-50 ml of sterile normal saline solution per irrigation, and monitoring of effluent color every 1-2 hours for clot formation, bladder spasms, and patient discomfort 2, 1
• Gentle aspiration may be necessary to extract clots, and the irrigation rate should be gradually decreased as bleeding subsides, with monitoring for return of hematuria after discontinuation, as recommended by the American Urological Association 2, 1
• A closed drainage system should be maintained, with avoidance of unnecessary disconnections and excessive pressure during irrigation, to prevent catheter-associated UTIs and bladder trauma, as recommended by the Infectious Diseases Society of America and the CDC 2
• Routine addition of antimicrobials or antiseptics to irrigation fluid is not recommended, and the catheter should be removed as soon as clinically possible to reduce infection risk, as recommended by the CDC and Infectious Diseases Society of America 2, 3
• Intermittent clean catheterization may be considered instead of permanent catheterization for long-term management, to reduce infection incidence, as recommended by the European Association of Urology 4, 1
• Intermittent irrigation with normal saline solution has not been shown to significantly reduce catheter obstructions in patients with long-term catheterization 2

Infection Prevention

• Maintain a closed drainage system and avoid unnecessary disconnections to prevent catheter-associated UTIs, as recommended by the Infectious Diseases Society of America 2
• Avoid excessive pressure during irrigation to prevent bladder trauma, and remove the catheter as soon as clinically possible to reduce infection risk, as recommended by the Infectious Diseases Society of America and the CDC 2, 3

Long-Term Management

• Consider intermittent clean catheterization instead of permanent catheterization for patients requiring long-term management, to reduce infection incidence, as recommended by the European Association of Urology 4, 1
• Intermittent irrigation with normal saline solution has not been shown to significantly reduce catheter obstructions in patients with long-term catheterization 2