Cystoclysis procedure, types, care

The cystoclysis (cystoclysis in English) is a urological technique that uses continuous irrigation of the urinary bladder through a Foley catheter, generally 3-way, to treat certain pathologies of the genitourinary system. The term is widely used in medical language, but it was not included in medical science dictionaries..

This procedure is used in cases of hematuria, obstruction of the urinary catheter and in certain cases of cystitis. Hematuria has various causes, for example, they can be spontaneous, postsurgical or traumatic but, regardless of the cause, they can generate clots and obstruct the urinary catheter.

In any case, it is necessary to keep the urinary catheter permeable so that it fulfills the objective for which it was placed, which is to drain the urine stored in the urinary bladder..

In this sense, cystoclysis is a procedure whose main objective is to maintain the patency of the tube, facilitating the elimination of blood and clots that can obstruct the passage of urine..

However, cystoclysis is also used to place certain medications such as some antibiotics and substances that promote hemostasis and that are used to treat hematuria such as "bismuth".

Article index

• 1 Procedure
  • 1.1 Materials
  • 1.2 Process
• 2 Kinds
  • 2.1 - Continuous cystocysis
  • 2.2 - Intermittent cystoclysis
• 3 Care
• 4 References

Process

Materials

To carry out this procedure the following supplies are needed:

-One sterile three-way Foley catheter.

-One 10cc injector.

-Lubricant.

-Sterile gloves.

-Sterile physiological solution.

-Sterile tubing system with dropper and closing clamp to connect the physiological solution to the probe.

-Urine collection bag.

Process

First, the irrigation system is assembled and purged. The liquid passage is closed and it is hung from the pole, taking care to leave the free end of the tubing inside the sterile plastic container or wrapped in a gauze with antiseptic so that it does not become contaminated..

Then the gloves are put on (after washing the hands), the catheter is lubricated and inserted through the urethra, fixed with 10cc of physiological solution with which the fixation balloon is inflated. One of the lines is connected to the irrigation system and the other line of the catheter is connected to the urine collection bag.

The probe placement protocol must be strictly followed to avoid contamination with the corresponding asepsis and antisepsis measures..

The system is set up in sterile conditions. Once assembled, the drip is opened and the physiological solution enters the system, from there it passes into the bladder and comes out again mixed with the urine and is deposited in the collection bag.

In the case of using any medication for local use, it is mixed with the physiological solution or injected directly into the irrigation line..

Types

There are two types of cystoclysis techniques: continuous cystoclysis and intermittent cystoclysis..

- Continuous cystoclysis

It consists of the continuous irrigation of the urinary bladder by means of a three-way Foley catheter in a closed system. This technique keeps the system sterile, both the irrigation system and the drainage system..

This prevents the penetration of bacteria and the formation of clots that would otherwise obstruct the tube.

- Intermittent cystoclysis

This technique can be applied using two different systems. The first consists of a closed irrigation system and the second an open irrigation system..

Intermittent cystoclysis with closed system

This technique uses a two-way Foley catheter that is connected to a urine collection bag and irrigation equipment through a “Y” connector..

In this way, harvesting and irrigation are alternated. When the irrigation is connected, it cannot be collected, but the route with which it is irrigated must be closed so that the urine mixed with the irrigation solution that accumulated in the bladder begins to flow.

Intermittent cystoclysis with open system

In this case, the probe is disconnected from the collection system and the saline solution is injected manually with a loaded syringe (50cc). This procedure is used to unclog the tube blocked by clots or mucus..

As previously indicated, the ultimate goal of these procedures is to maintain or restore patency of the urinary catheter in patients with hematuria. This prevents the formation and accumulation of clots that can obstruct the tube and prevent urine drainage.

Medications can be applied through the irrigation system directly into the bladder when needed.

It is indicated in moderate or severe hematuria that accompany carcinomas and other pathologies of the genitourinary tract, after kidney transplants, in closed kidney trauma or in bladder contusions..

Among the pathologies of the genitourinary tract that can generate hematuria, we can name acute prostatitis and other prostate diseases, urethral injuries such as strictures, fistulas and trauma

Care

Cystoclysis is contraindicated in trauma that perforates the urinary bladder since the irrigation would end outside the bladder and into the pelvic cavity. For any type of bladder lavage or irrigation, the irrigation fluid must be at room temperature and sterile.

Once the irrigation system is installed, the amount of serum introduced and the amount and characteristics of the fluid extracted must be recorded. The color, turbidity, the presence of clots, bloody fluid, etc. must be observed..

The urinary meatus should be cleaned daily and whenever it becomes dirty with soap and water. The probe should be turned longitudinally without traction, this mobilization is necessary to avoid adhesions. Frequent probe disconnection should be avoided.

Likewise, urinary retention caused by kinking of the catheters or their collection systems should be avoided, keeping the tubes always in a downward position and free of compressions.

The system must be secured to avoid traction trauma. The collection bag should be emptied periodically and aseptically.

In the event that the patient needs to be mobilized, the tube outlet must be clamped and the irrigation system closed. Care must be taken that the bag is always below the level of the bladder. As soon as possible, the patency of the system should be reestablished..

Indicators of urinary infection such as increased body temperature, chills, pain, and cloudy or foul-smelling urine should be assessed. If a UTI is suspected, a urine sample and the probe tip should be taken for a microbiological examination..

References

1. Chavolla-Canal, A. J., Dubey-Malagón, L. A., Mendoza-Sandoval, A. A., & Vázquez-Pérez, D. (2018). Complications in the use of a traditional urinary drainage bag with an antireflux valve versus a modified Chavolla version in patients with hematuria. Mexican Journal of Urology, 78(2), 119-127.
2. Grillo, C. (2015). Urology. Editorial FASTA University.
3. McAninch, J. W., & Lue, T. F. (Eds.). (2013). Smith & Tanagho's general urology. New York: McGraw-Hill Medical.
4. Suárez, E. B., Contreras, C. V., García, J. A. L., Hurtado, J. A. H., & Tejeda, V. M. G. (2005). Management of hematuria of bladder origin with bismuth solution as a hemostatic agent. Rev Mex Urol, 65(6), 416-422.
5. Wiener, C. M., Brown, C. D., Hemnes, A. R., & Longo, D. L. (Eds.). (2012). Harrison's principles of internal medicine. McGraw-Hill Medical.