Neurogenic Bladder
Bladder instillation with gentamicin or vinegar for prevention of bladder infections
Purpose of bladder instillation: People who do self-catheterization to empty their bladder can develop recurrent bladder infections.
To fight infections our first step is to make sure that the catheterization technique is clean. Our second step is to make sure the bladder pressures are under good control; urodynamics is a test we may perform to check bladder pressures. Our third step is often to start bladder irrigation, which is washing out of the bladder with tap water. When this doesn’t work, we do bladder instillation of vinegar and if that doesn’t work then we do bladder instillation of gentamicin. Instillation is different from irrigation in that the fluid stays in the bladder for several hours. Fig. 1: A full bladder with many bacteria (in green.)
Fig. 1
Steps of Bladder Instillation
Step 1: Catheterize as you normally would to empty the bladder. Fig. 2: An empty with bladder fewer bacteria.
Step 2: Perform bladder irrigation to get the bladder cleaned out (fig. 3).
Fig. 2
Fig. 3
Step 3: Prepare instillation solution. If gentamicin, your doctor will provide a prescription. If vinegar, dilute 1 part table vinegar in 19 parts tap water for a 5% solution (fig. 4).
Fig. 4
Step 4: Completely empty the bladder and then instill 30ml of gentamicin or vinegar mixture (fig. 5).
Fig. 5
Step 5: Remove the catheter and allow the gentamicin or vinegar to sit in the bladder overnight while you sleep. The liquid will come out when you catheterize next time. If you need to catheterize in the middle of the night, it is okay; you will get a little less exposure to the treatment but nothing bad will happen.
If you use a Foley catheter attached to a bag:
Follow the same instructions as above except that after instilling the gentamicin/vinegar into the bladder you clamp or plug the catheter for 30 minutes. If you cannot tolerate 30 minutes of catheter clamping/plugging then do as much time as you are able to do. Then, you can connect the catheter back to a bag.
You can ask your urology clinic for a clamp or plug. A plug looks like a plastic bullet that inserts into the end of your catheter.