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Q. I get blood in urine in Foley's catheter placed for urinary retention. Why?

Answered by
Dr. Ankush Jairath
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 13, 2020 and last reviewed on: Sep 04, 2020

Hello doctor,

I went into total urinary retention on March 14. I attended an ER and a foley's catheter was fitted, and I was advised that I had a slightly enlarged prostate (BHP). A week later, I was prescribed Tamsulosin 400 mcg. On March 26, the catheter was removed, but I went into retention again on March 30, and a new catheter was fitted in ER. Due to COVID-19, all tests have been canceled for over two months.

I now have a flip valve, on end of catheter (no bag needed). About two days out of seven, I get blood in my urine. I am concerned about the cause? When I open the tap on the catheter, I feel that, as the bladder empties, that it presses upon the tip of the catheter, which projects 40 mm into the bladder. Could the tip of the catheter be grating at the bladder wall, causing the bleeding? Is this a known problem? Is it possible to get a catheter, that projects less into the bladder? The bore size of the catheter is 16, and the brand is Folysil Porges.

I planed to ask a doctor to remove catheter, for trial. Should I take an antibiotic at that time as a precaution? A urine test has indicated some minor bacteria, but I was advised that this did not need treatment. If I go back into retention, I want to avoid a catheter that possibly injures my bladder. I am hoping that, my diet change, herbal remedies, plus Tamsulosin may allow me to normalize until proper tests are available. Also, could a virus infection aggravate moderate BHP to cause a blockage? PSA was 6.0 and done after the digital exam and while the catheter was in place. No signs of cancer.

#

Hi,

Welcome to icliniq.com.

Coming to your query, I will answer first your questions step by step.

For you doubt regarding, could the tip of the catheter be grating at the bladder wall and causing bleeding. Yes, but chances are minute and the amount of blood is also less. You can say sometimes clots can appear occasionally but significant amounts like urine coming in bag is mixed with blood (red urine) is quite rare. It is a known but uncommon problem.

There are small tip catheter available but indication to put them is not to avoid hematuria rather they are used to decrease irritative symptoms of the catheter. No antibiotic is necessary after removal of catheter but you should not discontinue Tamsulosin. Rather I will suggest you to have a antibiotic course of five days right now as it will cover UTI (urinary tract infection) as one of the cause for hematuria. And virus infection will not aggravate moderate BHP to cause a blockage.

Though the PSA was 6.0, still will suggest you to repeat it after 3 months once you are off catheter.

I want to ask you some questions. Are you a diabetic or hypertensive? How many days before you went into retention, urinary symptoms like poor flow, nocturia (getting up more than once at night time for passing urine), urgency, frequency, dribbling were present? Any history of surgery/catheterization for different reasons in the past? Any other medication you are taking chronically? Any history of hematuria in the past? Do you pass clots also anytime? Any relevant reports (ultrasound, urine culture, CBC, and RFT) you want to attach.

Please do reply.


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Thank you doctor,

I am not diabetic or hypertensive. I had not been aware of urinary symptoms, until retention happened. In hindsight, I would have had to urinate more often than 10 years earlier, but this did not appear excessive. Maybe every 2 to 3 hours, whereas, this would have been thee to four hours 10 years earlier. I did not have to get up at night.

I noticed that I was less comfortable holding out, but this was not a problem. Flow rate seemed normal, but it would often take me up to 15 to 20 seconds to commence flow, whereas, this was probably just 5 seconds when I was younger. I did not have any dribbling.

I never had catheterization in the past. I had my appendix removed when I was 2 years old. No other surgery and medications. I never had blood in urine, until catheter was fitted. And I never had any clots passed, until March 14th. Also, on March 26, when trial removal of catheter was undertaken, the nurse advised my to urinate into a bucket : I have a photo of that showing the blood clots discharged, in the seven hours after the catheter was removed. In this period, after removal of the catheter, the flow rate was noticeably poor, in a way I had never before suffered, intermittently reducing to a tiny spray.

I do not have any reports to share. I had an urtrasound scan done on March 31, when I went into retention the second time, and this indicated a volume of 1250 ml in my bladder. I enclosed the photo of the clots in urine.

#

Hi,

Welcome back to icliniq.com.

Drink a lot of water (so that your urine output over 24 hours) is more than at least 2 liters. You can take tablet Nitrofurantoin 50 mg HS. Continue until you have catheter in situ.

Start syrup Citra alka 10 ml TDS (its a urine alkalinizer to decrease urine acidity, if you have acidity then you can reduce the dose to 5 ml, you have to take it mix in water not directly). You have to continue tablet Tamsulosin 0.4 mg HS as before. If you were not having any urinary complaints before this episode then there are high chances that this time catheter free trial will be successful.

In case of failed trial two options are there.

1. Uro dynamics study of the bladder.

2. Cystoscopy examination.

About a short tip catheter it is 30 cc Lubricath Foley two way catheter, this model reduces the potential irritation caused by the catheter tip by rubbing the roof of the bladder. A shorter tip causes less tenting of the bladder roof.

I hope this helps.


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Thank you doctor,

I had the catheter removed on 1st May. This worked out and I have been operating relatively normally since then. On 27th May, I received a test results for recent urine test, and a PSA test. PSA level had increased to 11.9, and urine test indicated an infection of enterococcus faecalis. My GP prescribed Amoxicillin 500 mg thrice daily which I took for three weeks. This was followed by two weeks of Moxifloxacin. (five weeks in total).

A new PSA test on 1st July showed that the level had dropped to 3.9 and the urine test was negative. I had made steady progress regarding flow rate, with an average flow of 8ml/min in the morning, to about 14ml/min in the afternoon. I stopped all medication in mid-June. I had an MRI scan of the prostate yesterday, as I wanted to assess prostate size, and to eliminate the possibility of an abscess. I will try to upload the scan.

I am concerned with four white spheres, one in the prostate, and three near the seminal vessel. I understand that the scan shows that my prostate is enlarged. Perhaps, you can indicate by how much? But, my main concern is that does it have an abscess?

#

Hello,

Welcome back to icliniq.com.

It is good to know that you are doing well. I went through your query and attachment (attachment removed to protect patient identity).

Though I am not very good at reading it but according to quanta of my knowledge that white spot can be some calcification or residual infection. Size of which does not seems to be much. I do not think anything else is needed at the moment unless you have any kind of symptoms.

I hope this helps.


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