Bladder irrigation

Urological (bladder) irrigation solutions 7.4 Calcium alginate... 

Urinary candidiasis Fluconazole 200 mg IV or PO for 7-14 days OR Amphotericin B 0.3 mg/kg per day IV for 1-7 days Asymptomatic candiduria does not required therapy However, treatment is recommended in neutropenic, low-birth-weight infants, and patients undergoing urologic manipulations or those with renal allografts Amphotericin B bladder irrigation no longer recommended... 

The use of effective prevention strategies can decrease the incidence of hemorrhagic cystitis to less than 5% in patients receiving cyclophosphamide or ifosfamide. There are three methods to reduce the risk administration of mesna, hyperhydration, and bladder irrigation with catheterization. 

Continuous bladder irrigation by catheterization uses normal saline at 250 to 1000 mL/hour to flush acrolein from the bladder. Hyperhydration with normal saline at 3 L/m2 per day with intravenous furosemide to maintain urine output greater than 100 mL/hour also has been used with cyclophosphamide. Mesna is equivalent to both strategies in patients receiving high-dose cyclophosphamide and avoids the discomfort and... 

In the treatment of fungal meningitis or Candida urinary bladder infections, IV infusion alone is inadequate. It must be supplemented with intrathecal administration or bladder irrigation. 

Uses Hemoixhagic cystitis when saline bladder irrigation fails Action Astringent Dose 1-2% soln w/constant NS bladder irrigation Caution [+/-] Disp Powder for recons SE Encephalopathy possible can precipitate occlude catheters EMS None OD Not expected to produce life-threatening Sxs... 

In combination with neomycin, polymyxin B can be used as a bladder irrigant to reduce the risk of catheter-associated infections, although this use remains controversial. It also can be used as topical therapy in external otitis caused by P. aeruginosa. 

Fluconazole is very effective in the treatment of infections with most Candida spp. Thrush in the end-stage AIDS patient, often refractory to nystatin, clotrimazole, and ketoconazole, can usually be suppressed with oral fluconazole. AIDS patients with esophageal candidiasis also usually respond to fluconazole. A single 150-mg dose has been shown to be effective treatment for vaginal candidiasis. A 3-day course of oral fluconazole is effective treatment for Candida urinary tract infection and is more convenient than amphotericin B bladder irrigation. Preliminary findings suggest that Candida endophthalmitis can be successfully treated with fluconazole. Stable nonneutropenic patients with candidemia can be adequately treated with fluconazole, but unstable, immunosuppressed patients should initially receive... 

Usual irrigation dosage Continuous Bladder Irrigation 1 ml urogenital concentrate (contains 200,000 units polymyxin B, 57 mg neomycin) added to 1,000 ml 0.9% NaCl. Give each 1,000 ml >24 hr for up to 10 days (may increase to 2,000 ml/day when urine output >2 L/day). 

Generally replaced by the aminoglycosides or extended-spectrum penicillins for serious infections still used for bladder irrigation and gut decontamination used in combination wit hot her antibiotics and/or corticosteroids topically to treat infections of the eye and skin... 

There are other type of solutions that are used for peritoneal dialysis, anticoagulant solution, bladder irrigation and certain dermatological solution intended for application to broken surface. 

Local or topical administration of amphotericin has been used with success. Mycotic corneal ulcers and keratitis can be cured with topical drops as well as by direct subconjunctival injection. Fungal arthritis has been treated with adjunctive local injection directly into the joint. Candiduria responds to bladder irrigation with amphotericin B, and this route has been shown to produce no significant systemic toxicity. 

The nettle is rich in vitamins A and C and in minerals, particularly iron, potassium, and silica. Modern scientific studies have focused on its diuretic action. It lowers systolic blood pressure by increasing volume, die root treats symptoms of benign prostatic hyperplasia (BPH) by increasing urine flow and reducing residual urine. Nettle herb is also used for bladder irrigation and to prevent and treat bladder and kidney stones (see Chapter 66). 

Patients with a low surface to volume ratio may take considerably longer to cool by surface techniques. For these patients additional cooling can be provided by the use of chilled intravenous solutions, bladder irrigation, and gastric lavage. 

Phelps KR, Naylor K, Brien TP, Wilbur H, Haqqie SS. Encephalopathy after bladder irrigation with alum case report and literature review. Am J Med Sci 1999 318(3) 181-5. 

Fatal intoxication has followed prostatectomy and subsequent bladder irrigation with 3% boric acid (7). 

Schmid F, Zbinden J, Schlatter C. Zwei Falle von letaler Borsaurevergiftung nach Blasenspulung. [Two cases of fatal boric acid poisoning after bladder irrigation.) Schweiz Med Wochenschr 1972 102(3) 83-8. 

Glycine is an amino acid that is often used during transurethral prostatectomy for bladder irrigation, sometimes continuously for 24 hours after surgery. 

Mannitol is an osmotic diuretic that has been used in acute oliguric renal insufficiency, acute cerebral edema, and the short-term management of glaucoma, especially to reduce intraocular pressure before ophthalmic surgery. Other indications include promotion of the excretion of toxic substances by forced diuresis, bladder irrigation during transurethral resection of the prostate, and oral administration as an osmotic laxative for bowel preparation. Mannitol is used as a diluent and excipient in pharmaceutical formulations and as a bulk sweetener. 

For skin disinfection, chlorhexidine has been formulated as a 0.5% w/v solution in 70% v/v ethanol and, in conjunction with detergents, as a 4% w/v surgical scrub. Chlorhexidine salts may also be used in topical antiseptic creams, mouthwashes, dental gels, and in urology for catheter sterilization and bladder irrigation. 

Fluconazole 200 mg/day for 14 days hastens the time to a negative urine culture as compared with placebo treatment, but 2 weeks after the end of therapy, the frequency of a negative urine culture remains the same with both treatments. Short courses of therapy are not recommended treatment should include removal of catheters and stents whenever possible plus 7 to 14 days of therapy. Bladder irrigation with amphotericin B (50 mg in 500 mL sterile water instilled twice daily into the bladder via a three-way catheter) is only transiently effective. Minimal quantities (<3%) of amphotericin B are absorbed systemically from the bladder. ... 

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