A nurse is caring for a 70-year-old male client who underwent transurethral resection of the prostate (TURP) 24 hours ago. The client has a three-way urinary catheter with continuous bladder irrigation (CBI). Which nursing intervention should the nurse prioritize?

Monitoring urine output and adjusting irrigation flow to maintain light pink or clear drainage is the priority to prevent clot formation and bladder obstruction. Other options are less immediate or contraindicated in early post-TURP care.

Understanding the Postoperative Context
Following a transurethral resection of the prostate (TURP), the surgical site is a raw, vascular prostatic fossa. To prevent clot retention—a painful and dangerous obstruction—a three-way catheter is placed to provide continuous bladder irrigation (CBI). The primary goal of CBI is to mechanically wash out blood and small clots, maintaining catheter patency. The immediate postoperative period, specifically the first 24 hours, carries the highest risk for active bleeding. Therefore, vigilant monitoring of the irrigation system is the cornerstone of nursing care to prevent complications like bladder overdistension, clot formation, and subsequent hemodynamic instability.

Analysis of the Priority Intervention
The correct answer is to monitor the color and consistency of urine output and adjust the irrigation flow rate appropriately. This intervention directly addresses the most critical safety risk in the first 24 hours post-TURP: hemorrhage and catheter obstruction. A recent prospective study on a sensor-based CBI system highlights that the standard of care relies on nurses’ clinical judgment to titrate the irrigation rate based on the visual appearance of the outflow ^[1]. If the drainage is bright red or contains visible clots, the flow rate must be increased to prevent clot formation and retention. Conversely, as bleeding subsides and urine clears, the rate is reduced to avoid bladder distension and patient discomfort. The development of digital monitoring systems, such as the VisIMon device, underscores the clinical challenge of this task; these systems aim to provide real-time, objective hematuria grading to reduce the subjectivity and inter-observer variability inherent in manual visual inspection ^[2]. Failure to recognize dark, concentrated outflow or a sudden decrease in drainage can rapidly lead to catheter blockage, bladder spasms, and clot retention, which may require manual irrigation or surgical intervention.

Why the Other Options are Incorrect
Option 2: Encourage the client to perform Kegel exercises every hour while awake. While Kegel exercises are a valuable non-pharmacological intervention for strengthening the pelvic floor and managing post-prostatectomy urinary incontinence, their implementation is not a priority in the immediate 24-hour postoperative window. A meta-analysis on postoperative nursing for TURP patients confirms that pelvic floor muscle training is effective for reducing the incidence and volume of urinary incontinence during the recovery phase . However, immediately after surgery, the focus must be on acute surgical complications. The presence of a three-way catheter also makes effective Kegel exercises difficult and uncomfortable. This intervention is more appropriately introduced after catheter removal.

Option 3: Administer prescribed pain medication only when the client reports severe pain. This approach is outdated and contradicts modern pain management principles. In the context of CBI, a common source of discomfort is catheter-related bladder discomfort (CRBD), often described as an intense urge to void or painful bladder spasms. A systematic review on managing bladder spasms with indwelling catheters emphasizes that pharmacological interventions, including antimuscarinics, are effective for both prevention and management of CRBD . Waiting for pain to become severe before treating it can lead to increased anxiety, heightened sympathetic response, and a cycle of pain and spasm that may worsen bleeding. A proactive, scheduled or patient-controlled analgesia approach is preferred to keep the client comfortable and minimize bladder irritability.

Option 4: Remove the urinary catheter within 12 hours. Removing the catheter prematurely, especially within 12 hours after TURP, is contraindicated. The three-way catheter serves the dual purpose of draining urine and facilitating continuous bladder irrigation to clear the surgical field. The duration of CBI and catheterization is determined by the degree of hematuria, typically continuing for at least 24 to 48 hours until the effluent is clear or light pink without clots. Early removal would eliminate the mechanism for irrigation, dramatically increasing the risk of clot retention, urinary obstruction, and the potential need for emergency re-catheterization, which could traumatize the healing prostatic fossa. The systematic review on postoperative nursing interventions confirms that reducing catheter-related complications involves maintaining proper drainage and irrigation, not premature removal .