What is the medical term for clots in the bladder?

Intravesical Clots: Medical Terminology and Management

The medical term for clots in the bladder is "intravesical clots" or "bladder clot retention." This condition represents a urological emergency requiring prompt intervention to prevent complications such as urinary retention and further bleeding 1.

Etiology and Clinical Presentation

Intravesical clots can develop from various causes:

• Bladder tumors (most common cause, approximately 45% of cases) 2
• Prostate cancer or benign prostatic hyperplasia
• Radiation cystitis
• Trauma to the urinary tract
• Iatrogenic causes (post-surgical)
• Bleeding disorders or anticoagulant therapy
• Chronic cystitis

Clinical presentation typically includes:

• Hematuria (microscopic or gross)
• Urinary retention
• Suprapubic pain or discomfort
• Difficulty or inability to void
• Blood at the urethral meatus (in 37-93% of cases) 3

Diagnostic Approach

When intravesical clots are suspected:

1. Urinalysis with microscopy to confirm hematuria (≥3 RBCs per high-powered field) 1
2. Retrograde cystography is the diagnostic procedure of choice for suspected bladder injuries or to evaluate clot burden 1
3. CT scan with delayed phase imaging is recommended when evaluating for bladder injuries and potential clot formation 1, 3
4. Direct visualization via cystoscopy may be necessary to assess clot burden and identify underlying causes

Management

Intravesical clots represent a urological emergency and must be treated immediately, even during times of pressure on healthcare systems 1. Treatment options include:

Conservative Management

• Bladder irrigation with normal saline via a large-caliber urethral catheter (20-24 Fr)
• Manual evacuation using a Toomey syringe

Advanced Clot Evacuation Techniques

• Hydrogen peroxide irrigation: A simple and effective method for bladder clot evacuation with success rates of approximately 87% 4
• Enzymatic dissolution: Using chymotrypsin in sodium bicarbonate solution (40,000 U in 50 mL of 5% sodium bicarbonate) with success rates around 86% 5
• Thrombolytic therapy: Intravesical instillation of alteplase (0.5-1 mg) for resistant clots 6

Surgical Intervention

• Cystoscopic evacuation for resistant clots
• Transurethral resection if the underlying cause is a bladder tumor
• Open surgical intervention in severe cases

Follow-up and Prevention

• CT scan with delayed phase imaging is the method of choice for follow-up of bladder injuries and evaluation of clot resolution 1
• Address underlying causes to prevent recurrence
• For patients with recurrent clots due to radiation cystitis or tumors, consider preventive measures such as continuous bladder irrigation

Special Considerations

• Patients on anticoagulant therapy require evaluation for clots even while continuing their medication 1
• In patients with pelvic fractures, the risk of bladder injury and subsequent clot formation is significantly higher (present in 60-90% of cases) 3
• Delayed diagnosis or treatment can lead to complications such as urinoma formation, intra-abdominal abscesses, and potential kidney damage 3

Prompt recognition and management of intravesical clots is essential to prevent complications and identify potentially serious underlying conditions.