Urinary Bladder Tamponade (Blood Clots in the Bladder)
Aetiology and symptoms
Preceded by a urological intervention (catheterization, bladder puncture, transurethral resection of the prostate [TURP]).
Bleeding caused by a bladder tumour.
Sequelae of pelvic radiotherapy.
Anticoagulant therapy predisposes to bladder tamponade but does not cause it.
Usually the patient has had haematuria already before the tamponade, and as the condition persists, painful urinary retention will develop.
There may be a blood clot visible at the urethral orifice.
First aid
Start intravenous fluid therapy to ensure adequate circulating blood volume.
Perform catheterization with an open-ended Ch 20-24 irrigation catheter, or as an alternative, with two-way catheter. If the condition in a male patient is preceded by TURP, you may simultaneously try to lift the operated prostate with a finger through the rectum. The catheter must be reliably in the bladder (urine flow is clearly seen, or in a male patient the catheter is inside the urethra for almost all of its length) before the balloon is filled. The bladder should be repeatedly flushed using a 100 ml syringe until no more clots come out and the catheter remains patent. If a three-way catheter is available, start continuous rapid flow-through lavage with saline solution in order to keep the catheter open.
The bladder must not be filled with lavage solution unless one is certain that it also flows out; otherwise there is a significant risk of bladder rupture.
Bleeding after prostate interventions may stop with gentle pulling where a weight of approximately 200 g is attached to the catheter and let hanging. This requires, however, sufficient pain medication, and the pulling should not be continued for more than 2 hours.
Tranexamic acid (1 g 3 times daily) either orally or added to the lavage solution may be of benefit.
Haemotamponade usually requires further treatment in a hospital (the bleeding may continue). After first aid the patient is primarily referred to a surgical emergency department. During transportation the catheter should be in place in the bladder.