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Bladder Tamponade: Diagnosis and Treatment

Definition

Bladder tamponade is a bladder filled with blood clots due to hematuria with difficult voiding and risk of urinary retention.

Intravenous urography of bladder tamponade: large round filling defect in the bladder. With kind permission, Prof. Dr. R. Harzmann, Augsburg.

Etiology of Bladder Tamponade:

• Iatrogen: after urologic surgery (TURB, TURP, partial nephrectomy, PNL).
• Diseases: kidney cancer, bladder cancer or prostate cancer, benign prostatic hyperplasia, hemorrhagic cystitis, vascular diseases and other causes of hematuria.
• Risk factors: platelet dysfunction, therapy with anticoagulants.

Signs and symptoms:

LUTS, passage of blood clots via the urethra, pelvic pain, urinary retention. In the absence of therapy, bladder rupture with urine extravasation is possible.

Diagnosis:

• Ultrasound imaging shows a variable bladder filling with echogenic clots [fig. US of bladder tamponade].
• Blood count and cross-matching for significant bleeding.
• Further imaging is unnecessary for postoperative bleeding [fig. IVP of bladder tamponade], for unknown hematuria, see diagnostic workup of hematuria.

Ultrasound imaging of bladder tamponade (sagittal plane): round echogenic lesion in the full bladder.

Treatment of Bladder Tamponade

Acute and low-grade bladder tamponades can be removed with the help of catheters by aspiration with a bladder syringe (preferably via a rigid catheter 20–24 CH). Ensure sufficient analgesia for this painful procedure. After removing the tamponade, an irrigation catheter is inserted, and continuous irrigation is done depending on the intensity of the hematuria.

Pronounced bladder tamponades, especially with active bleeding of the lower urinary tract, necessitate treatment in general anesthesia: aspiration of the tamponade over the shaft of the resectoscope, followed by coagulation of the bleeding area. To treat significant upper urinary tract bleeding, see treatment of the underlying disease.

References

  Deutsche Version: Harnblasentamponade

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