Question: Hi Dr. I had a patient who underwent TURP 4 days ago. Then, 2 days post-op, became unable to urinate and started passing clots. Went to the surgeon and inserted a 2-way silicone F/C then was re-admitted. While inpatient, F/C is draining cherry-cranberry like output, no clots. However, the next day, started passing small clots, 3 per shift. The catheter balloon burst but it wasn't found out until the next day after. However, patient continued to drain good amount of urine with color changing from cherry-cranberry like, then maroon color, then cranberry like color again with small 3-4 clots after each irrigation. However, proper irrigation was not done as it was instilled through the port where the balloon must be inflated which cause the bursting of balloon, we assumed what had happened. Anyway, the catheter was pulled out in an attempt today to insert another 3 way-24 Ch/Fr F/C but patient was already able to urinate. He's emptying good amount of urine for 4 hours with cranberry like color, then started passing 3 small clots and the urine is turning darker. Then, passed a very huge clots, size of a palm and looks like a liver and urine is turning bright red. He has passed 1 more huge clot after that. It continued for several hours up to now but clots are getting smaller but urine still remains the same (bloody). So, he's been urinating bloody urine for 6 hours already. VSS stable, asymptomatic. Now, what would be causing such large/huge clots? Would it be from not irrigating it properly for the last 2 days and maybe an old clots sitting in the bladder for a while or would it be a trauma from F/C? CBC has been ordered. What else would we expect from this?

I have followed up the patient from night nurse and said that had persistent bright red urine and voiding had cease @ 0200 this morning. They had to reinsert another F/C (16 Fr) as on bladder scan revealed 900 cc urine in the bladder. Also, small clots were being passed out after the huge clumps of clots. What would stop the voiding if he already passed a lot of clots? Would it be another clots?