Information
Editors
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.