A new treatment for clot retention: intravesical streptokinase instillation.

Abstract

A 12-year-old boy with acute renal failure and hypertension caused by tubulointerstitial nephritis underwent ultrasound guided renal needle biopsy in February 1995. The day after biopsy the patient was referred to our urology department because of massive hematuria. After evaluation we placed a 12F multiple hole urethral Robinson catheter and irrigated the bladder with saline. However, clot retention developed 4 days later. Pelvic ultrasonography revealed a 55 mm. hematoma in the bladder (fig. 1). A total of 100,000 IU streptokinase was diluted with 100 ml. saline, 30 ml. of this solution were injected into the bladder via the catheter and the catheter was clamped for 30 minutes. Later the bladder was irrigated with saline, which easily evacuated the clots. This procedure was repeated 3 times at 4-hour intervals. After 3 applications the urine was clear and no bladder hematoma was seen on followup ultrasonography (fig. 2). Hematocrit was stable during the procedure. Serum coagulation studies were not altered. Voiding cystourethrography before renal biopsy demonstrated no vesicoureteral reflux.