Clot Retention
Clot retention is bladder outlet blockage by blood clot — relieve it with a large-bore three-way catheter, manual washout and continuous bladder irrigation, then find and treat the cause of the bleeding.
The big picture
Heavy haematuria (from BPH, bladder/prostate cancer, post-TURP/TURBT, infection, anticoagulation) forms clots that plug the bladder outlet, causing painful retention. The bladder is full of clot that a small catheter cannot evacuate.
Large three-way catheter + manual washout + continuous irrigation clears clot retention; a small catheter makes it worse — then hunt for the bleeding cause.
Red flags
It will block immediately — use a large-bore three-way catheter.
Take to theatre for cystoscopic clot evacuation ± fulguration.
Correct coagulation and review anticoagulation alongside mechanical clearance.
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Mechanically clear the clot and keep the outflow patent, support the patient, and treat the underlying bleeding source.
Complications
- Anaemia/haemorrhagic shock
- Bladder over-distension injury
- Recurrent retention
- Catheter trauma, urethral injury
- Irrigation fluid issues
- Use an adequate catheter; evacuate clot fully; maintain irrigation
- Correct coagulopathy
- Re-washout, theatre evacuation, transfuse, treat the source
If treatment fails
If clot will not clear, ask: is the catheter big enough and patent, has all clot been evacuated, and is there active bleeding needing fulguration?
Memory hooks
Big three-way catheter, not small.
Washout by hand, then CBI.
Won't clear → theatre.
Then find the bleeding cause.
Board traps
Clot retention managed with a small catheter → worsens; use a large three-way.
Irrigation started without manual clot evacuation.
Treating the retention but ignoring an underlying bladder tumour.
Clinical cases
An 80-year-old man on warfarin presents with painful inability to void and heavy haematuria. The bladder is distended. A nurse has inserted a 12 Fr catheter that immediately blocked with clot.
What is the correct management?