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Underwent TURP. Started passing clots and unable to urinate. Is this normal?

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Hi Dr. I had a patient who underwent TURP 4 days ago. Then, 2 days post-op, became unable to urinate and started passing clots. Went to the surgeon and inserted a 2-way silicone F/C then was re-admitted. While inpatient, F/C is draining cherry-cranberry like output, no clots. However, the next day, started passing small clots, 3 per shift. The catheter balloon burst but it wasn't found out until the next day after. However, patient continued to drain good amount of urine with color changing from cherry-cranberry like, then maroon color, then cranberry like color again with small 3-4 clots after each irrigation. However, proper irrigation was not done as it was instilled through the port where the balloon must be inflated which cause the bursting of balloon, we assumed what had happened. Anyway, the catheter was pulled out in an attempt today to insert another 3 way-24 Ch/Fr F/C but patient was already able to urinate. He's emptying good amount of urine for 4 hours with cranberry like color, then started passing 3 small clots and the urine is turning darker. Then, passed a very huge clots, size of a palm and looks like a liver and urine is turning bright red. He has passed 1 more huge clot after that. It continued for several hours up to now but clots are getting smaller but urine still remains the same (bloody). So, he's been urinating bloody urine for 6 hours already. VSS stable, asymptomatic. Now, what would be causing such large/huge clots? Would it be from not irrigating it properly for the last 2 days and maybe an old clots sitting in the bladder for a while or would it be a trauma from F/C? CBC has been ordered. What else would we expect from this?
Posted Wed, 7 Nov 2012 in Urinary and Bladder Problems
Answered by Dr. Muhammad Ishfaq Habib 2 hours later

Thanks for the query

Patient who have undergone TURP are persistently irrigated for atleast 48 hours after the surgery. During this period urine initially is bloody (fresh blood)and turns bright red for some period; but after the 12-24 hours the urine would change its color from bright red to orange and then yellow and then normal. This is a sign that the wound has stopped bleeding.

Occasionally the healing of the wound can be delayed and bleeding may continue for a while especially when the patient is not irrigated properly. Now as it was not properly irrigated probably it had resulted in the formation of blood cloths within the bladder. The huge clumps of blood are most probably those blood clots.

In this circumstance, the thing to do next is have continuous irrigation until the urine is clear of blood clots and transparent. It may also be a good idea to administer transamin (Tranexamic acid) through intravenous injections for atleast two days. It would help in stopping the bleeding. Discuss with his treating doctor.

CBC is essential as bleeding of such amount might have lowered his Hb. Please follow it up.

Hope this answers your query. If you still have some queries, feel free to ask.

Above answer was peer-reviewed by
Follow-up: Underwent TURP. Started passing clots and unable to urinate. Is this normal? 5 hours later
I have followed up the patient from night nurse and said that had persistent bright red urine and voiding had cease @ 0200 this morning. They had to reinsert another F/C (16 Fr) as on bladder scan revealed 900 cc urine in the bladder. Also, small clots were being passed out after the huge clumps of clots. What would stop the voiding if he already passed a lot of clots? Would it be another clots?
Answered by Dr. Muhammad Ishfaq Habib 10 minutes later
Thanks for the query

The voiding is stopped is most likely due to blockage of the catheter lumen by blood clots. As I told you the irrigation needs to be continuous with any stoppage and fast along with the administration of the transamine.

Be cautious about frequent change of catheters it may cause trauma or may perforate the bladder or urethra. Don't change catheter when voiding stops but try to wash it with 50cc syringe with normal saline. It will clear the clots that have blocked the catheter.

If you still have some queries, feel free to ask.

Above answer was peer-reviewed by
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