Introduction

Learning objectives

Recognize when gross hematuria is an emergency.
Know the initial management of urinary retention due to clots.
Remember that, once the bleeding is controlled, its cause must be investigated.

Video lesson

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Video pending upload (embedded YouTube)

Summary

Why is it an emergency?

Gross hematuria can form clots inside the bladder.

These can obstruct the bladder outlet and cause urinary retention due to clots.

Initial evaluation

We must assess:

hemodynamic stability;
severity of bleeding;
presence of clots;
ability to urinate;
hemoglobin;
anticoagulation;
urologic history.

Initial management

When there is retention due to clots, a urinary catheter of adequate caliber may be needed, usually a three-way catheter.

The goal is to:

evacuate the clots;
restore drainage;
keep the bladder free of new clots.

Manual bladder irrigation can be performed, followed by continuous bladder irrigation when indicated.

Something essential

Controlling the bleeding does not mean the problem is solved.

Once the patient is stabilized, the cause of the hematuria must be investigated.

Possibilities include:

urinary tract tumors;
stone disease;
infection;
prostatic disease;
trauma;
iatrogenic causes.

Key concept

Hematuria + clots + inability to urinate → think of retention due to clots.

PDF

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Practical algorithm

Is the patient stable? If not → immediate stabilization.
Is there infection associated with obstruction? If so → antibiotics + urgent drainage.
Is there an organ whose viability is time-dependent? Testicular torsion → urgent surgery. Ischemic priapism → urgent treatment.
Is there an obstruction that needs drainage? Urinary retention → drain the bladder. Retention due to clots → evacuate clots and maintain drainage. Infected urinary obstruction → drain the upper urinary tract.

In urological emergencies, the initial goal is often not to definitively resolve the disease, but to recognize the risk, stabilize the patient, and drain or preserve the organ when appropriate.

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Hematuria with clots