The reasons and countermeasures of Bladder Rupture caused by Transurethral Clot Evacuation

[Urinary bladder tamponade-an urological emergency]

BACKGROUND

Urinary bladder tamponade is a urological emergency that is part of the clinical routine of every urologist and requires immediate and adequate diagnosis and therapy.

OBJECTIVES

Presentation of the clinical picture of urinary bladder tamponade including etiology, diagnostics, and therapy as well as formulation of recommendations for action for clinical routine.

MATERIALS AND METHODS

Structured presentation of the diagnosis and therapy of urinary bladder tamponade with practical recommendations for action based on a current literature search and a clinical case study.

RESULTS

Urinary bladder tamponade is a usually painful filling of the urinary bladder with blood clots as part of gross hematuria. The central pillars of diagnostics are anamnesis, targeted physical examination, and sonography. Therapy involves the rapid insertion of a flushing catheter with manual evacuation of the tamponade. A flushing catheter with at least 20 French should be used here.

CONCLUSION

Timely diagnosis and prompt treatment are crucial. This usually includes transurethral catheter insertion with manual evacuation. If the tamponade is unsuccessfully removed, further measures such as endoscopic evacuation or, as a last resort, sectio alta or radical cystectomy are available.

Intravesical Agents in the Treatment of Bladder Clots in Children

Bladder blood clots represent an infrequent urinary condition in children. They usually result from hematuria with many underlying causes, such as urinary tract infections and urethral/bladder traumas. Treatment options for clot removal include trans-urethral or suprapubic bladder irrigation and, if unsuccessful, endoscopic management under general anesthesia with a resectoscope. In younger male children, however, the repeated passage of a trans-urethral resectoscope may be challenging and traumatic, due to the small lumen diameter. Eventually, an open surgical approach can be required in many patients. Few anecdotal non-surgical approaches have been proposed for the management of bladder blood clots in children. This review aims to summarize the conservative techniques described in the literature with the instillation of intravesical agents, analyzing the different strategies and their advantages.

Removal of large fibrotic bladder blood clots using prostatic tissue morcellator under real-time ultrasound guidance

Objective

Large fibrotic bladder blood clots are difficult to treat via conventional methods. Hence, we investigated the safety and reliability of real-time ultrasound guidance combined with prostate tissue morcellator in the removal of large fibrotic bladder blood clots in this study.

Methods

We chose 9 patients with large fibrotic bladder blood clots who were treated in our department from January 2019 to December 2020. Under the condition that conventional methods were ineffective in removing the bladder blood clot, real-time ultrasound guidance combined with a prostatic tissue morcellator was used to remove the large fibrotic bladder blood clot through the steps of positioning, breaking, adjusting repositioning and recrushing. After removal, the bipolar electrocautery was replaced to stop bleeding of the bladder mucosa.

Results

All patients successfully underwent the operation. After the blood clot was removed, the bladder mucosa was examined. There was no damage to the bladder mucosa or muscle layer. The urine was clear at the end of the procedure with slow irrigation, and no bleeding was found again.

Conclusion

Real-time ultrasound guidance combined with a prostate tissue morcellator was a safe, effective and quick method for the removal of large fibrotic bladder blood clots.