[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › BPH and prostate surgery: continuous bladder irrigation, clots, TUR syndrome and continence

# BPH and prostate surgery: continuous bladder irrigation, clots, TUR syndrome and continence

- Procedure

After prostate surgery the nurse keeps the catheter draining with irrigation, watches the urine colour and clots, looks for TUR syndrome and teaches continence.

Updated Nov 13, 2026

## Key points

- The urine is bloody at first and should lighten over a few days; a darker colour or clots means more bleeding.
- No drainage with lower abdominal pain or distension means a blocked catheter: act and call.
- True urine output = total drained minus irrigation infused: record both.
- TUR syndrome: headache, confusion, vomiting, shortness of breath, low blood pressure, an irregular pulse, seizures; it comes from fluid absorbed during surgery.
- After the catheter comes out some leakage is common; pelvic floor exercises help and control returns over months.

## What it is

After transurethral resection of the prostate (TURP) and similar operations the patient returns with a urinary catheter, and the bladder may be irrigated continuously to keep it clear of clots. The urine is bloody at first and usually clears within a few days. Nursing care keeps the catheter draining, adjusts the irrigation as ordered by the colour of the drained fluid, records irrigation in and out to know the true urine output, treats bladder spasms, and watches for bleeding, a blocked catheter and TUR syndrome (fluid absorbed during surgery, with low sodium, confusion and fluid overload). Before discharge it teaches catheter care, continence exercises and warning signs.

## Indications

- The first days after TURP or other prostate surgery with a urinary catheter.
- Continuous bladder irrigation ordered to prevent clot retention.
- Preparing the patient for discharge with or without a catheter.

## Contraindications and precautions

- Use only the irrigation solution and route ordered; follow the institutional protocol for the irrigation rate.
- Ask the surgeon before anticoagulants, antiplatelets or anti-inflammatories are given or restarted.
- For bladder washout or irrigation technique, follow the catheter irrigation page and the protocol.

## Equipment

- Three-way catheter with the closed irrigation and drainage system.
- Irrigation solution as ordered, and a drainage bag that can be emptied and measured.
- Intake–output chart with separate columns for irrigation in and fluid out.
- Vital-sign monitor.

## Step by step (and why)

- Check that the catheter drains freely and the tubing has no kinks — a blocked catheter fills the bladder with clots.
- Look at the colour of the drained fluid at each check and adjust the irrigation as ordered — the colour guides the rate.
- Record irrigation infused and total drained, and subtract — this gives the real urine output.
- Ask about lower abdominal pain and feel for a full bladder — pain with less drainage suggests a blockage.
- If the catheter seems blocked, follow the protocol to clear it and call — a blocked catheter with irrigation running overfills the bladder.
- Take vital signs and assess mental status — TUR syndrome and bleeding change them first.
- Treat bladder spasms with the medicine ordered — spasms cause pain and leakage around the catheter.
- Help with turning, leg exercises, coughing and deep breathing — they prevent clots in the legs and lung problems.
- Teach catheter care, plenty of water unless restricted and avoiding constipation — constipation can delay healing.
- After catheter removal, teach pelvic floor exercises and check that the patient passes urine — leakage is common at first.

## Complications

- Bleeding with clots and clot retention.
- TUR syndrome: fluid overload, low sodium, confusion, seizures.
- Bladder spasms and leakage around the catheter.
- Urinary infection, urinary retention after removal, urethral narrowing later.
- Leakage, erection problems and retrograde ejaculation after surgery.

## Next step: when to call for help

- Call if the catheter does not drain, or for lower abdominal pain or a full bladder.
- Call if the fluid turns darker red or shows more clots.
- Call at once for confusion, headache, nausea, vomiting, shortness of breath or a seizure after surgery.
- Call for a temperature of 38 °C or more, cloudy or bad-smelling urine, or leg pain or swelling.
- After removal, call if the patient cannot pass urine or the stream is very weak.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is the bladder irrigated continuously after a TURP?

To keep the bladder clear of clots so the catheter does not block; the drained colour guides the rate as ordered.

## How is the true urine output calculated during continuous bladder irrigation?

Total fluid drained minus the irrigation infused over the same period.

## What is TUR syndrome, and which signs suggest it?

Fluid absorbed during surgery causing overload and low sodium: headache, confusion, vomiting, shortness of breath, seizures.

## What does the nurse suspect if drainage stops and the patient has lower abdominal pain?

A catheter blocked by clots; the nurse follows the protocol to clear it and calls.

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## Connections

## Related 4

- [Suprapubic catheters, external catheters and catheter irrigation](https://durgical.com/en/nursing/suprapubic-catheters-external-catheters-and-catheter-irrigation/)
- [Indwelling catheter care and removal](https://durgical.com/en/nursing/indwelling-catheter-care-and-removal/)
- [Fluid balance: recording intake and output](https://durgical.com/en/nursing/fluid-balance-recording-intake-and-output/)
- [Urinary catheterization](https://durgical.com/en/nursing/urinary-catheterization/)

## Related conditions 3

- [Benign prostatic hyperplasia](https://durgical.com/en/conditions/benign-prostatic-hyperplasia/)
- [Prostate cancer](https://durgical.com/en/conditions/prostate-cancer/)
- [Acute urinary retention](https://durgical.com/en/conditions/acute-urinary-retention/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Transurethral resection of the prostate, MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/002996.htm) (MedlinePlus, US National Library of Medicine, 2025); [Transurethral resection of the prostate - discharge, MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/patientinstructions/000300.htm) (MedlinePlus, US National Library of Medicine, 2025); [Koo CH, Ryu JH. Anesthetic considerations for urologic surgeries. Korean J Anesthesiol](https://europepmc.org/article/PMC/PMC7113163) (Korean Journal of Anesthesiology (Europe PMC, open access), 2020); [Layangool T et al. Visualizing grades of hematuria for communication enhancement and continuous bladder irrigation guidance. Urol Ann](https://europepmc.org/article/PMC/PMC13441034) (Urology Annals (Europe PMC, open access), 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/bph-and-prostate-surgery-continuous-bladder-irrigation-clots-tur-syndrome-and-co/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/bph-and-prostate-surgery-continuous-bladder-irrigation-clots-tur-syndrome-and-co/