What should I do if I'm passing blood clots and have strong urine odor, with an abnormal computed tomography (CT) scan and a scheduled cystoscopy in a few weeks?

Immediate Urologic Evaluation Required

You need urgent urologic evaluation within 24-48 hours, not in a few weeks—passing blood clots with an abnormal CT scan represents a potentially serious urologic emergency that cannot wait for a scheduled cystoscopy. 1, 2

Why This Cannot Wait

• Passing blood clots indicates significant active bleeding that requires immediate assessment, as clot formation suggests substantial hematuria that can lead to clot retention and acute urinary obstruction 3, 2
• The combination of gross hematuria (blood clots), abnormal CT findings, and foul-smelling urine raises concern for bladder cancer, severe infection, or other serious pathology that demands prompt evaluation 1, 2
• Any patient with painless gross hematuria requires urgent upper tract imaging and cystoscopy regardless of age, as approximately 80% of bladder cancer patients present with painless hematuria 3, 2

Immediate Actions Required

Contact Your Urologist Today

• Call the urologist who ordered your cystoscopy and explain you are passing blood clots—this should trigger an urgent appointment within 1-2 days, not weeks 1, 2
• If you cannot reach your urologist or they cannot see you urgently, go to the emergency department 2

What to Expect at Urgent Evaluation

Immediate cystoscopy should be performed rather than waiting weeks, as this is the definitive diagnostic procedure for evaluating gross hematuria with abnormal imaging 1, 2

The urologist will likely:

• Perform office cystoscopy immediately to visualize the bladder and identify the bleeding source 2, 4
• Obtain urine cytology at the time of cystoscopy (not before) to evaluate for malignant cells 1, 2
• Review your CT scan results to correlate imaging findings with cystoscopic findings 2, 4

Why the Strong Urine Odor Matters

• Foul-smelling urine combined with hematuria and clots suggests possible concurrent infection or tissue necrosis, which can occur with bladder tumors or severe inflammatory conditions 3, 2
• However, do not treat presumed infection without cystoscopic evaluation when gross hematuria is present, as the underlying cause must be identified first 3, 1

Potential Complications of Waiting

Clot Retention Risk

• Blood clots can accumulate in the bladder and cause acute urinary retention, requiring emergency catheterization and bladder irrigation 5
• Clot evacuation may require urgent cystoscopy under anesthesia if retention develops 5

Delayed Cancer Diagnosis

• If bladder cancer is present, waiting weeks delays definitive diagnosis and staging, potentially allowing disease progression 2, 4
• Approximately 25% of patients with delayed evaluation may have muscle-invasive disease that requires more aggressive treatment 2

Critical Pitfalls to Avoid

• Do not wait for your scheduled cystoscopy appointment when passing blood clots—this represents a change in clinical status requiring urgent re-evaluation 3, 1
• Do not request urine cytology or additional tests before seeing the urologist—cystoscopy is the definitive test and should not be delayed 1
• Do not assume this is "just an infection" because of urine odor—gross hematuria with abnormal imaging requires cystoscopic evaluation regardless of other symptoms 3, 1, 2
• Do not take antibiotics without urologic evaluation first unless you have fever or systemic symptoms suggesting sepsis 3

If You Cannot Get Urgent Urologic Care

Go to the emergency department if:

• You develop inability to urinate (suggests clot retention) 5
• You have fever, chills, or flank pain (suggests infection or obstruction) 3
• Bleeding becomes more severe or you feel lightheaded/weak 5
• Your urologist cannot see you within 48 hours 1, 2

The emergency department can perform urgent cystoscopy if needed, place a catheter for clot evacuation if retention occurs, and coordinate immediate urologic consultation 5