Clot retention

Definition

Clot retention is the accumulation of blood clots in the bladder, impairing urinary drainage.

Causes: tumor bleeding, bleeding after TURP, trauma, anticoagulants.

Clinical assessment

• Pain, vesical tenesmus.
• Inability to void or passage of blood with small clots.
• Signs of hypovolemia in massive blood loss.

Diagnosis

• Ultrasonography: clots, distended bladder.
• Hemoglobin, hematocrit.
• Coagulation profile, review of anticoagulants.

Emergency management

1. Large-bore three-way catheter (22–24 Ch).
2. Clot evacuation by irrigation with sterile solution (normal saline) using a Janet syringe.
3. Continuous irrigation if bleeding persists.
4. If unsuccessful, perform cystoscopy with clot evacuation and hemostasis (electrocoagulation, laser).
5. In massive bleeding, activate the approved major hemorrhage and transfusion protocol; involve an anesthesiologist/intensivist and the transfusion service. Document indications, patient and blood component identification, compatibility, timing, monitoring, and reactions.

After bleeding has stopped

• Monitor hemodynamics and hemoglobin.
• Assess the cause of bleeding.
• Plan definitive treatment (tumor, prostate, coagulopathy).

Algorithm