رجل عمره ٦٩ سنة بعد استئصال البروستاتا عبر الإحليل بـ ٦ ساعات، على غسيل مثانة مستمر. البول صار أحمر غامقاً مع جلطات، وتوقف التصريف تقريباً، والمريض يشتكي ألماً وتقلصات شديدة أسفل البطن، والمثانة منتفخة. ما أول إجراء؟

A 69-year-old man is 6 hours after TURP on continuous bladder irrigation. The drainage has become dark red with clots and has almost stopped; he has severe lower abdominal pain and spasms with a distended bladder. What is the first action?

1. Remove the catheter immediately and replace it tomorrow
2. Stop the inflow and hand-irrigate the catheter as ordered
3. Give an IV diuretic to rapidly increase urine output
4. Increase the irrigation rate to maximum to push the clots through

Answer: B) Stop the inflow and hand-irrigate the catheter as ordered. Clots can block the catheter so the bladder fills with irrigant and spasms painfully. Stop inflow, hand-irrigate per protocol and notify the provider if bleeding persists.