A bladder washout, also known as bladder irrigation, is a common non-surgical medical procedure used to clear the lower urinary tract. This technique involves flushing the bladder with a sterile solution to remove debris obstructing the normal flow of urine. The washout is performed by temporarily introducing a sterile catheter into the bladder, allowing for the instillation and subsequent removal of the flushing fluid. This targeted intervention restores the functionality of the urinary system when compromised by internal blockages.
Reasons for Bladder Washout
The primary purpose of a bladder washout is to resolve or prevent the physical obstruction of urine drainage, usually within an existing indwelling catheter. The most common indication is clot retention—the presence of blood clots—which often occurs following urological surgeries. Procedures like Transurethral Resection of the Prostate (TURP) or Transurethral Resection of a Bladder Tumor (TURBT) can cause significant bleeding, leading to fibrous clots that plug the catheter.
Thick mucus and sediment also necessitate a washout, particularly in patients with anatomical alterations, such as a bladder augmentation. The intestinal tissue used in these procedures continues to produce mucus, which accumulates and leads to recurrent catheter blockages. If not cleared, this debris increases the risk of developing urinary tract infections or bladder stones (calculi). Removing debris through a washout can also aid in managing severe infections where blockage prevents adequate drainage.
How the Procedure is Performed
The bladder washout procedure involves a step-by-step technique to physically clear the obstruction. The process begins after confirming the catheter is correctly placed, using sterile equipment like a 50- or 60-milliliter syringe and sterile normal saline solution. If the patient has a three-way catheter, the irrigation port is used; otherwise, the main drainage port is disconnected from the collection bag.
The method involves manual, intermittent irrigation, where a measured volume of the sterile saline is gently instilled into the bladder through the catheter. Introducing the fluid with a slight, controlled speed can help to dislodge the obstructing material, such as a thick clot or sticky mucus plug. Once the solution is instilled, the syringe is used to aspirate, or draw back, the fluid, which ideally brings the debris out of the bladder along with it.
This instill-dwell-aspirate cycle is repeated until the fluid draining back through the catheter appears clear and free of debris. A maximum volume of 100 to 200 milliliters is usually instilled at one time to avoid over-distending the bladder and causing discomfort.
Potential Complications and Recovery
Patients undergoing a bladder washout may experience temporary discomfort during the procedure, most commonly due to the bladder distending as the fluid is instilled. The most frequent complication is the occurrence of bladder spasms, which are sudden, involuntary contractions of the bladder muscle that feel like a cramping pain. These spasms are often triggered by the irritation of the bladder lining or the presence of a clot.
There is also a risk of minor bleeding or further irritation to the bladder lining, especially if the procedure is performed forcefully. Furthermore, every time the sterile catheter system is opened to perform the washout, there is a small risk of introducing bacteria, which can lead to a hospital-acquired infection. Medical staff carefully monitor the patient’s output and comfort level throughout the procedure to minimize these risks.
Following the washout, recovery expectations focus on monitoring the clarity and volume of urine output. Patients are often advised to increase their fluid intake for the next day or two to help naturally flush the urinary tract system. If the procedure is successful, the patient should experience a return to normal, unobstructed urine flow. Patients should seek immediate medical attention if they develop a fever, experience persistent, severe pain, or if the catheter becomes blocked again shortly after the washout, indicating a potential recurrence or an emerging infection.