From the Research
Hematuria and urethral pressure after nephrostomy tube placement and with a Foley catheter in place requires immediate attention, and I recommend continuous bladder irrigation with normal saline to prevent clot formation and maintain catheter patency, as suggested by the most recent study 1. This presentation is concerning for possible clot formation or catheter obstruction. While some bloody output from both the nephrostomy tube and Foley catheter is expected immediately after nephrostomy placement, significant hematuria with urethral pressure suggests potential complications. The low bladder scan volume (46 ml) indicates the bladder is relatively empty, which is appropriate with a functioning Foley. Key considerations in this scenario include:
- Monitoring vital signs, hemoglobin levels, and urine output closely
- Urgent urological consultation if hematuria persists or worsens, or if the patient develops signs of hemodynamic instability
- The urethral pressure sensation may indicate catheter irritation, bladder spasms, or developing obstruction
- Consideration of antispasmodics like oxybutynin 5mg three times daily if bladder spasms are suspected, as mentioned in general management principles 2. This situation requires close monitoring as post-procedural bleeding should gradually improve rather than worsen over time, and the approach should be guided by the most recent and relevant evidence 1.