Information
Editors
Urinary Bladder Tamponade (Blood Clots in the Bladder)
Aetiology and symptoms
- Bladder tamponade is often preceded by a urological intervention (catheterization, bladder puncture, transurethral resection of the prostate [TURP]).
- 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 16-20 catheter made of PVC (which remains patent during suction). 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 100-200 ml syringe with isotonic saline to remove clots. If a three-way catheter is available, start continuous rapid flow-through lavage with saline solution in order to keep the catheter open.
- Bleeding after TURP may stop with gentle pulling of a three-way catheter, the balloon of which is filled with 30 ml of saline. It is of utmost importance to hold the penis in an upward direction to avoid urethral trauma.
- Oral tranexamic acid (1 g 3 times daily) may be of benefit in some cases after catheterization.
- 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.