Bladder instillations and urological surgery

Question 1

Bladder infection

Answer 1

• Various solutions are available as irrigations or washouts. Aqueous chlorhexidine can be used in the management of common infections of the bladder but it is ineffective against most Pseudomonas spp. Solutions containing chlorhexidine 1 in 5000 (0.02%) are used but they may irritate the mucosa and cause burning and haematuria (in which case they should be discontinued); sterile sodium chloride solution 0.9% (physiological saline) is usually adequate and is preferred as a mechanical irrigant.
  Continuous bladder irrigation with amphotericin 50 mcg/mL may be of value in mycotic infections in adults.

Question 2

Dissolution of blood clots

Answer 2

Clot retention is usually treated by irrigation with sterile sodium chloride solution 0.9% but sterile sodium citrate solution for bladder irrigation 3% may also be helpful.

Question 3

Bladder cancer

Answer 3

Bladder instillations of doxorubicin hydrochloride p. 901 and mitomycin p. 919 are used for recurrent superficial bladder tumours. Such instillations reduce systemic side-effects; adverse effects on the bladder (e.g. micturition disorders and reduction in bladder capacity) may occur.
Instillation of epirubicin hydrochloride p. 902 is used for treatment and prophylaxis of certain forms of superficial bladder cancer; instillation of doxorubicin hydrochloride is also used for some papillary tumours.
Instillation of BCG (Bacillus Calmette-Guérin p. 958), a live attenuated strain derived from Mycobacterium bovis is licensed for the treatment of primary or recurrent bladder carcinoma in-situ and for the prevention of recurrence following transurethral resection.