170 J. REYNARD AND N. COWAN
BLADDER WASHOUT FOR BLOCKED CATHETER
This may be required after TURP or TURBT. Try to avoid the problem by ensuring that the nursing staff is familiar with this potential complication. Nurses should be aware of the importance of keeping the catheter bag empty and ensuring that there is always a sufficient supply of irrigant solution. If the urine collection bag becomes full, urine flow ceases and the catheter can become blocked with clot.
The patient will complain of lower abdominal pain, and the bladder will be distended (dull to percussion and tense to palpation). Look at the irrigation channel of the three-way catheter. There will be no flow of fluid out of the bladder. A small clot may have blocked the catheter or a chip of prostate may have stuck in the eye of the catheter.
Attach a bladder syringe to the end of the catheter and pull back. This may suck out the clot or chip of prostate and flow may restart. If it does not, draw some irrigant up into the syringe until it is about half-full and forcefully inject this fluid into the bladder. This may dislodge (and fragment) a clot that has stuck to the eye of the catheter. If the problem persists, change the catheter. The obstructing chip of prostate may appear on the end of the catheter as it is withdrawn.
If the bladder is full of clot, then it is sometimes possible, by alternating irrigation and sucking back on the syringe, to remove the clot, but if there is a large quantity in the bladder, you may well have to return the patient to the operating room, remove all the clot by reinserting the resectoscope and applying an Ellik evacuator, and then find and cauterise the bleeding vessel that caused the problem in the first place.
The same technique should be used for post-TURBT catheter blockage as for post-TURP catheter blockage. However, beware of applying overvigorous pressure to the bladder following resection of a tumour, since the wall of the bladder will have been weakened at the site of tumour resection and it is possible to perforate the bladder. This is particularly so with the thin bladders of elderly women.