When the prostate is removed the surgeon has to put the bladder back together with the urethra. A catheter is placed to “stent” this area of the anastomosis. The reason a catheter is used and left in from 6-14 days is to allow time for this area to heal. In doing so keeping urine from leaking out into the area where the prostate was removed.
So…you have the bladder sewed to the urethra and going through this is a catheter. The catheter, a foley catheter, has a balloon on it that keeps it from falling out. The balloon is just inside the bladder on the proximal side of the anastomosis.
There is a space around the catheter that allows both blood and urine to leak around the catheter, through the anastomosis, and then out the tip of the penis, not through the catheter, but around it.
In the case of urine “flooding” around the catheter, this occurs because a bladder spasm forcibly pushes urine not through the catheter but around it. This is unfortunate and not ideal and is the result of a bladder spasm. The bladder spasm occurs because the balloon is about the size of a golf ball and the bladder doesn’t like it in there and tries to spit it out by contracting, much as it would do to eliminate urine. Sometimes the cause is a clot or something inside the foley preventing urine from draining so the bladder and the urine take the next easiest course….the bladder expels it not through the catheter, but around it.
In the case of blood coming out around the catheter and showing up at the tip of the penis, it is a similar scenario and is not big deal. In this case blood from the anastomosis or blood in and about the anastomosis finds its way down along side of the catheter and then out the penis. As long as the urine in the bladder and subsequently inside the foley and the collection tubing is patent and draining well, bloody or not, urologists are fine with the situation.
So flooding around the catheter is common and the result of a bladder spasm and should be short-lived, unless the catheter is blocked and in that case it must be irrigated free of clots or an obstruction. Blood around the catheter is very common and not an issue of concern.
If there are clots inside the foley and the bladder cannot drain…that is a problem. Manual irrigations will usually unobstruct the foley. Unlike any other prostate or bladder endoscopic surgery, the options for the patient and urologist after a prostatectomy are limited. You can’t take out the foley and just put it back in because of fear that one might disrupt the anastomosis. So extreme care should be taken in irrigating the catheter and in no circumstances should a nurse remove a catheter after a prostatectomy because of it not functioning properly. Hopefully, gentle irrigation will resolve the majority of cases where a prostate has been removed and yet the catheter is draining improperly.