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Toomey Syringe

The Toomey syringe (catheter-tip syringe) is the manual bladder-irrigation syringe: a wide-barrel irrigation and aspiration syringe available as a 60 mL tapered-tip model that seats in a catheter funnel, including a Foley, Coudé, or three-way catheter, and as a 70 mL model supplied with catheter and Luer adapters[9][10]. Toomey syringes are used for manual bladder washout (MBW), tissue or clot evacuation through a catheter, and intravesical povidone-iodine instillation described in a selected NLUTD/CIC cohort.[2][9][10]

Design​

  • 60 mL barrel (50 mL reusable glass and 70 mL variants also exist).[9][10][13]
  • Tapered smooth catheter tip slips directly into the catheter funnel with a friction seal; no Luer adapter required.
  • Wide internal bore accepts small clot fragments, mucus, and tissue chips on aspiration without clogging.
  • Flanged plunger supports one-handed thumb-and-finger irrigation-aspiration cycles.
  • Disposable polypropylene; reusable autoclavable glass variants are historical.

Reconstructive / Functional Urology Uses​

Manual Bladder Washout for Clot Retention​

The dominant use. The Toomey is the irrigation arm of the CATCH-22 protocol (Clarebrough 2018), a structured manual-bladder-washout pathway for inpatient clot retention. In this prospective service study, referring teams inserted 16–20 Fr catheters and washed out a mean 145 mL, and nearly all needed upsizing. The urology service used a mean 5,392 mL and evacuated a mean 617 mL of clot. The authors recommend a catheter of at least 22 Fr and washing out until no more clot returns plus 1 L (the "clot + 1 L" rule).[1]

Technique: use a 50–60 mL syringe for repeated normal-saline irrigation and suction until no further clot returns; the CATCH-22 authors recommend a further 1 L of washout after the last clot.[1] Forceful but controlled; over-pressurization in a small-capacity, trabeculated or neurogenic bladder risks bladder perforation, and under-volume irrigation just moves clot around.

The companion catheter physics (lumen geometry, eyelet pattern, three-way versus two-way) are addressed on the Three-Way Catheter page.

Post-Procedure Bladder Irrigation​

After TURP / HoLEP chip evacuation by Ellik, after open bladder closure, and after urethroplasty or fistula-repair cases with intravesical work, some surgeons finish with a gentle Toomey washout through the catheter to clear residual blood, chip remnants and debris. Whether to wash out, and how forcefully, depends on the operation and the surgeon's orders; avoid it over a fresh bladder closure or anastomosis.

Intravesical Medication Instillation​

The Toomey is the standard instillation device for non-oncologic bladder agents in the reconstructive / functional urology space:

  • Povidone-iodine bladder irrigation for recurrent UTI prevention in NLUTD patients on CIC. In a prospective single-center before-and-after study of 119 patients with NLUTD on CIC and recurrent UTIs, daily intravesical povidone-iodine was followed by large reductions in symptomatic UTIs, ED visits and hospitalizations (IRR 0.008 for symptomatic UTI).[2]
  • DMSO, heparin or lidocaine instillations used for IC / BPS symptom relief.
  • Intravesical antibiotic instillation in selected NLUTD or catheterized patients, per institutional protocol (nonstandard).
  • Bladder priming for urodynamics or VCUG when a gravity drip is not set up; barrel as funnel with the plunger removed.

(Intravesical chemotherapy and BCG instillation for bladder cancer is the oncology use case, outside WARWIKI scope.)

Catheter Patency / Troubleshooting​

The Toomey can be used for gentle bedside irrigation when a Foley may be obstructed, after checking the catheter and the need to irrigate.[11] Gentle manual instillation and aspiration with a 50 mL catheter-tip syringe can help assess a clot-occluded catheter; document the volume instilled and returned and reassess if flow is not restored.[11] Confirm position and drainage clinically, and by ultrasound if needed.

Bedside / OR-Adjacent Adjunct Uses​

  • Wound and graft irrigation. Buccal-graft bed, donor-site irrigation, perineal-wound copious-irrigation pre-closure.
  • Donor-site rinse during STSG harvest with the irrigant of choice.
  • Bedside cystoscopy bladder fill when the dedicated tubing is unavailable; barrel-as-funnel.

When Toomey Fails — Adjuncts for Tenacious Clot Retention​

The Toomey is rate-limited by the operator's hand and the catheter calibre. When standard MBW does not clear the clot:

AdjunctMechanismEvidence
Direct sheath-to-wall-suction (up to 250 mmHg, as reported) via cystoscopyCentral suction through a 25 Fr cystoscope or 26 Fr resectoscope sheath in the reported seriesGoel 2011 case series of 15 adults who had failed Ellik evacuation[8]
Chymotrypsin + sodium bicarbonate intravesical irrigationEnzymatic clot dissolutionBo 2014 series: 19 of 22 men treated successfully[3]
Hydrogen peroxide bladder irrigationOxidative clot dissolutionXu 2020 retrospective series: clot cleared in 27 of 31[4]
OR cystoscopy with Ellik evacuationLarger-bore sheath, mechanical chip retrievalOperative option when bedside MBW fails[14]
Open / robotic cystotomy with clot evacuationDirect visualizationLast-line salvage; reserved for surgical bladder or persistent uncontrollable retention

Toomey vs Standard Syringes vs Bulb Syringe​

DeviceCapacityCatheter interfaceBest fit
Toomey syringe60 mL (50 mL glass / 70 mL variants)Tapered open tip → catheter funnelBladder irrigation, MBW, intravesical instillation[2][9][10][15]
Luer-lock 60 mL syringe60 mLLuer-lock → adapter required[16]General irrigation; not catheter-funnel compatible
Asepto bulb syringe60 or 80 mL (BOENMED models)[17]Open tapered tipWound irrigation, cavity rinsing; less controlled vacuum on aspiration
Ellik evacuatorContinuous-cycle bulbSheath-mountedChip / clot evacuation through resectoscope sheath during transurethral cases

Catheter Pairing for Maximum Flow​

Effective MBW depends as much on the catheter as the syringe. Bench studies show that catheter design changes washout efficiency. In a gelatin-clot bladder model with 22 Fr catheters, a 6-hole catheter cleared more simulated clot than a Malecot design (77.0% residual clot with the Malecot versus 60.4% with the 6-hole catheter after five cycles).[5] In a mechanical model, catheters with a larger total hole area, and an open end with a side hole near the tip, needed less force to clear pseudo-clot.[6] A flow-meter study of 16–26 Fr three-way catheters found that Bardex 22 and 24 Fr outperformed Dover through the irrigation port and during continuous irrigation, while manual irrigation through the drainage port was similar.[7] These are laboratory findings. See the Three-Way Catheter page for the catheter side of the pairing.

CATCH-22 recommends at least a 22 Fr catheter for clot retention; the referring teams' 16–20 Fr catheters nearly all needed upsizing.[1]

Limitations​

  • Operator-power-limited. The hand-driven pressure ceiling is far below wall-suction or true cystoscopic evacuation.
  • Trabeculated, small-capacity or NLUTD bladder. Over-vigorous instillation risks bladder perforation; consider smaller instilled volumes and frequent aspiration in this group.
  • Recent bladder anastomosis or fresh cystotomy closure. Manual irrigation must be gentle because increased bladder pressure can disrupt sutures or perforate the bladder; after open bladder surgery, obtain a urology practitioner order and use an experienced clinician.[12]
  • Friction-seal slip. The tapered tip occasionally backs out under pressure; brace the catheter funnel with the non-dominant hand.

Historical Context — David Toomey​

The catheter-tip syringe carries the name of its designer, Toomey, and remains the standard hand syringe for catheter irrigation.

See also: Ellik Evacuator, Three-Way Catheter, Bladder Scanner.

References​

1. Clarebrough E, McGrath S, Christidis D, Lawrentschuk N. "CATCH-22: a manual bladder washout protocol to improve care for clot retention." World J Urol. 2018;36(12):2043–2050. doi:10.1007/s00345-018-2346-z

2. Moussa M, Chakra MA, Papatsoris AG, et al. "Bladder irrigation with povidone-iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization." Neurourol Urodyn. 2021;40(2):672–679. doi:10.1002/nau.24607

3. Bo J, Yangyang Y, Jiayuan L, et al. "Evaluation of bladder clots using a nonsurgical treatment." Urology. 2014;83(2):498–9. doi:10.1016/j.urology.2013.09.022

4. Xu M, Jin L, Shan Y, Zhu J, Xue B. "A simple and effective method for bladder blood clot evacuation using hydrogen peroxide." J Int Med Res. 2020;48(5):300060520924546. doi:10.1177/0300060520924546

5. Mesfin S, Sarkissian C, Malaeb B, Monga M. "Catheter design for effective manual bladder irrigation." J Urol. 2011;186(6):2307–9. doi:10.1016/j.juro.2011.07.080

6. Kobatake K, Inoue S, Takemoto K, et al. "Evaluation of urinary catheters for effective manual bladder washout." Sci Rep. 2022;12(1):14359. doi:10.1038/s41598-022-18778-5

7. Braasch M, Antolak C, Hendlin K, et al. "Irrigation and drainage properties of three-way urethral catheters." Urology. 2006;67(1):40–4. doi:10.1016/j.urology.2005.07.007

8. Goel A, Sengottayan VK, Dwivedi AK. "Mechanical suction: an effective and safe method to remove large and tenacious clots from the urinary bladder." Urology. 2011;77(2):494–6. doi:10.1016/j.urology.2010.09.035

9. Romsons. Toomey Syringe (GS-6015): product specifications. Accessed October 4, 2026.

10. Aster Medispro. Toomey Tip Syringe: instructions for use, AI-GP-007-R2/0924. 2024.

11. NSW Agency for Clinical Innovation. "Manual irrigation." Bladder irrigation toolkit. https://aci.health.nsw.gov.au/networks/urology/resources/bladder-irrigation/manual.

12. NSW Agency for Clinical Innovation. "Manual irrigation." Bladder irrigation toolkit. https://aci.health.nsw.gov.au/networks/urology/resources/bladder-irrigation/manual.

13. Top Syringe Manufacturing Company. "Toomey Irrigation / Evacuating Glass Syringes." Manufacturer product specifications. https://www.glass-syringe.com/Toomey_Irrigation_Evacuating_Glass_Syringe.html.

14. Stride K, van Jaarsveld N, John V, John J. "Hydrogen peroxide bladder irrigation: A simple, safe and effective management option for clot retention." Urol Case Rep. 2023;51:102579. doi:10.1016/j.eucr.2023.102579

15. Top Syringe Manufacturing Company. "Toomey Irrigation / Evacuating Glass Syringes." Manufacturer product specifications. https://www.glass-syringe.com/Toomey_Irrigation_Evacuating_Glass_Syringe.html.

16. Medline. "Luer Lock Syringes." Diagnostic Products Catalog. Product catalog

17. BOENMED. "Asepto Bulb Irrigation Syringe." Manufacturer product specifications. Product page