Bladder tamponade is an indication for surgery. Bleeding into the bladder after prostate surgery

Bladder tamponade can be a consequence of diseases of the genitourinary system, as well as the result of injuries. The main reasons are:

upper urinary tract injuries;
neoplasms of the upper urinary tract;
bladder neoplasms;
varicose veins of the urinary reservoir and prostate gland;
damage to the prostate capsule due to the capsule rupturing.

Bladder cancer is a common cause

Development mechanism

How the process develops largely depends on the origin of the pathology. For example, with a sudden rupture of the prostate capsule, the process proceeds as follows. Rupture and tension of the capsule occurs due to the growth of the prostate gland and obstruction in it.

There is constant pressure on the muscle that relaxes the bladder, as well as on the neck of the bladder. It is formed due to the fact that it is necessary to overcome infravesicular blockage. Changes in pressure inside the bladder and a large volume of the prostate gland create conditions that lead to capsule rupture. As a result, hematuria occurs.

What are the reasons for incomplete emptying of the bladder?

Incomplete emptying of the bladder is felt mainly in diseases of the lower parts of not only the urinary but also the reproductive system in women and men.

Frequent urination in men should not always be considered normal. Even if the frequent urge to empty the bladder is not accompanied by discomfort, discharge and other alarming symptoms, the patient should consult a specialist.

Causes

All causes of frequent urination in men can be divided into 2 groups. The first includes physiological ones, in most cases associated with errors in diet or stress. The second group includes pathological causes associated with various diseases of the genitourinary and other systems.

Bladder cystostomy in men

Ischuria affects men more often than women and children, so they are given a cystostomy more often. Men also experience more discomfort from it, because... their organ is arched.

Indications for its application:

Prostate diseases (adenoma or tumor). Adenoma is an indication for cystostomy in men. As it progresses, it enlarges the prostate gland and can compress the urethra. Ischuria develops. Often the adenoma degenerates into adenocarcinoma, which risks blocking the urethra.
Operations on the bladder or penis. With such interventions, it is often necessary to apply a special catheter.
Neoplasms of the bladder or pelvis have become increasingly common. Tumors are localized in different places, but the most dangerous are at the mouth of the ureter or urethra. If the tumor is in the place where the bladder passes into the urethra, then within a few months its growth will lead to anuria (urine will stop flowing into the bladder).
The urethra is blocked by a stone or foreign body. This is a consequence of urolithiasis. The stone can pass through the urethra for more than one day. This interferes with the flow of urine and prevents a catheter from being inserted. Rescue in cystostomy.
There is pus in the bladder, requiring it to be washed out.
The penis is injured.

Carrying out diagnostics and a therapeutic course in some cases requires installing a catheter in the patient’s bladder. Most often, the tube is inserted through the urethra, but it is also possible to place it through the abdominal wall, located in front. The catheter performs the following important functions:

removes urine;
flushes the bladder;
helps administer the medicine.

Causes

Symptoms

The main manifestations of bladder tamponade are pain when trying to urinate, the urge either does not have an effect, or a small amount of urine is released. Upon palpation, a bulge is detected above the pubis; this is a full bladder. The slightest pressure on it causes pain. A person with bladder tamponade is emotionally labile and has restless behavior.

Based on determining the volume of blood in the bladder, the degree of blood loss is determined. Urine contains fresh or altered blood impurities. It is worth considering that tamponade of the urinary reservoir involves bleeding. The capacity of the bladder in a male is about 300 milliliters, but in fact the volume of lost blood is much larger.

Symptoms of a bladder rupture

Therefore, a sick person has all the signs of blood loss:

pale and moist skin;
heartbeat;
weakness and apathy;
dizziness;
increase in heart rate.

The main complaints of a patient with tamponade will be pain in the area of the urinary reservoir, inability to urinate, painful and ineffective urge, dizziness, blood in the urine.

Anemia is one of the complications of the pathological condition

Prostate adenoma: catheterization or surgery?

When the bladder is full, it is quite easy to carry out medical manipulations, because the organ is greatly stretched, which means its size is increased. In addition, the anterior wall of the bladder is not protected - it is not covered by the peritoneum, but is only adjacent to the abdominal muscles.

Technique for performing the procedure:

The patient lies down on the operating table, the medical staff fixes his legs, arms, and slightly lifts him in the pelvic area.
To prevent infection by pathogenic bacteria, the puncture area is thoroughly disinfected with a special solution. If there is hair at the puncture site, then this area is shaved in advance (before the puncture).
Next, the doctor palpates the patient to determine the highest point of the organ and its approximate location, then anesthetizes with 0.5% novocaine, injecting the solution 4 cm above the pubic symphysis.
After the onset of anesthesia, a puncture is performed using a 12 cm needle, the diameter of which is 1.5 mm. The needle is slowly inserted through the anterior abdominal wall, piercing all layers, eventually reaching the wall of the organ. Having pierced it, the needle is deepened by 5 cm and the urinary fluid is removed.
After complete emptying, the needle is carefully removed so as not to cause bleeding, then the bladder cavity is washed with an antibacterial solution.
The puncture area is disinfected and covered with a special medical bandage.

The development of specific complications after puncture is a rare occurrence. However, if medical workers neglected the rules of asepsis, then the penetration of pathogenic microorganisms leading to inflammation is likely.

Serious complications include:

abdominal puncture;
bladder perforation;
injuries to organs located near the puncture organ;
urine getting into the fiber that is located around the organ;
purulent-inflammatory process in the fiber.

Despite possible complications and risks, puncture is sometimes the only method of helping the patient. The quality of its implementation and the patient’s postoperative period almost entirely depend on the experience of the surgeon.

Bladder catheterization is a temporary measure for adenoma if there are complications (infections) or the need to flush the bladder and divert urine after transurethral resection (TUR). This is the gold standard for treating adenoma when residual urine appears.

Adenoma cannot be treated with catheterization; if conservative treatment (drugs such as doxazosin and finasteride, herbal medicine) does not provide an effect, it is necessary to decide on surgery. Depending on the volume of the prostate, minimally invasive laser (vaporization and enucleation) and standard (TURP) operations can be performed.

They cannot refuse you surgery because of your age; the heart problem is solved together with a cardiologist and anesthesiologist during the preparation for the operation. If you are refused surgery by one specialist, find another, a third, go to a specialized clinic and regional center, today adenoma can be successfully treated at any age, a catheter with a urine bag is not a death sentence!

Suprapubic capillary puncture: indications for use

Suprapubic capillary puncture is performed when the bladder is full, in case of acute urinary retention, when the patient is unable to empty himself naturally. This manipulation is resorted to when it is impossible to release urine from the bladder using a catheter. More often, such a procedure is necessary in case of injury to the external genitalia and urethra, in particular with burns, in the postoperative period. In addition, suprapubic puncture is performed for diagnostic purposes to collect high-quality urine samples.

This manipulation allows us to obtain pure material for medical research. Urine samples do not come into contact with the external genitalia. This allows you to create the most accurate picture of the pathology than with analyzes using a catheter. Capillary puncture is considered a reliable method for examining urine in newborns and small children.

Bladder puncture technique

Before carrying out the manipulation, medical workers prepare the puncture area: the hair is shaved and the skin is disinfected. In some cases, the patient is examined using an ultrasound machine to accurately determine the location of the urinary canal. The surgeon can examine the patient and, without special equipment, determine the boundaries of the overfilled bladder.

For the operation, the patient must lie on his back. General anesthesia is not used for this procedure; the puncture area is anesthetized using local anesthetic drugs. Then a special long needle is inserted under the skin to a depth of 4-5 centimeters above the pubic joint. The needle penetrates the skin, abdominal muscles, and pierces the walls of the bladder.

The doctor must make sure that the needle goes deep enough so that it cannot slip out. After this, the patient is turned over on his side and tilted slightly forward. Urine flows through a tube attached to the other end of the needle into a special tray. After the bladder is completely emptied, the needle is carefully removed and the manipulation site is treated with alcohol or sterile wipes.

If necessary, bladder puncture is repeated 2-3 times a day. If the procedure needs to be performed regularly, the bladder is punctured and a permanent catheter or drainage is left in place to remove urine. If urine is needed for testing, it is collected in a special syringe with a sterile cap. Before sending the material for testing to the laboratory, the contents are poured into a sterile tube.

Main indications for puncture:

Contraindications to catheterization/inability to remove urine through a catheter.
Injuries to the external genitalia, trauma to the urethra.
Urine collection for reliable laboratory testing.
The bladder is full, and the patient is unable to empty it independently.

Suprapubic puncture is a safe way to examine urinary fluid in young children and infants. Often, patients themselves prefer organ puncture, since when using a catheter the likelihood of injury is much higher.

Indications for the procedure

Suprapubic (capillary) puncture of the bladder can be performed for two purposes - therapeutic, that is, therapeutic, and diagnostic. In the first case, the puncture is performed to empty the organ in order to avoid its rupture due to excessive accumulation of urine.

The diagnostic purpose is to take a urine test. But this method is used quite rarely, although the analysis taken in this way is much more informative than that obtained by self-urination or catheterization.

If the cystic formation is small and does not manifest itself in any way, patients need to be examined by ultrasound twice a year to monitor the situation.

A common unpleasant consequence of manipulation with a puncture of the urethra is urethral fever. It can occur due to bacteria entering the blood. This happens when the urethra is injured by medical instruments. This complication is accompanied by chills and intoxication of the body. In more severe forms, urethral fever can provoke the occurrence of prostatitis, urethritis or some other serious diseases.

In addition, incorrect or too hasty manipulation can lead to false channel moves. There is a risk of urine flowing into the abdominal cavity and tissue. In order to prevent unwanted leakage, healthcare workers are advised to insert the needle not at a right angle, but obliquely.

Contraindications

Indications for bladder puncture are all those cases when the patency of the urethra is impaired and there is acute urine retention. For example, for injuries and burns of the genital organs.

Clarification of the cause of erythrocyturia.

Better analysis of urine that is not contaminated with foreign flora of the external genital organs.

Identifying the cause of leukocyturia.

Surgery is contraindicated for:

Tamponade.
Paracystitis, acute cystitis.
Small capacity bubble.
Hernia of the inguinal canal.
Neoplasms in the bladder of a benign or malignant type.
Obesity of the third stage.
The presence of scars on the skin in the area of the intended puncture site.

Like any other invasive procedure, bladder puncture has its contraindications. These include:

insufficient fullness - if the organ is empty or even half full, puncture is strictly prohibited, since there is a high risk of complications;
pathological blood clotting - coagulopathy;
period of bearing a child;
the patient has a hemorrhagic diathesis.

Hemorrhagic diathesis is a contraindication to manipulation

The list of contraindications continues:

history of dissection of the anterior abdominal wall along the linea alba below the navel;
confusion, enlargement or stretching of the peritoneal organs;
the presence of inguinal or femoral hernias;
inflammation of the bladder - cystitis;
abnormalities of organs that are located in the pelvis (cysts, sprains);
infectious lesion of the skin at the puncture site.

There are cases when puncture is impossible. This procedure is prohibited to perform in case of various injuries of the bladder and its low capacity. Manipulation is not advisable for men with acute prostatitis or prostate abscesses. The procedure is prohibited for women during pregnancy. Complications during this manipulation can also occur in patients with complex forms of obesity.

Other contraindications to puncture are:

acute cystitis and paracystitis;
bladder tamponade;
neoplasms of the genitourinary organs (malignant and benign);
purulent wounds in the area of the operation;
inguinal hernias;
scars in the puncture area;
suspicion of bladder displacement.

A cystostomy is a hollow tube through which urine is removed directly from the bladder and collected in a special bag that temporarily replaces the bladder. A regular catheter is inserted directly into the urethral canal, and a cystostomy is inserted through the peritoneal wall.

Such a catheter is necessary when the bladder does not empty, although it is full. This happens when:

A regular catheter cannot be inserted.
It is believed that the patient will have difficulty urinating for a long time, and a cystostomy is placed for a long time.
The patient has acute ischuria (urinary retention)
The urethra (urethra) is damaged due to pelvic trauma, medical or diagnostic procedures, or during sexual intercourse.
It is necessary to determine the daily volume of urine, but it is impossible to place a regular catheter through the urethra.

Cystostomy eliminates the manifestation of many diseases when urination is impossible. But she does not treat them, but restores the flow of urine.

If the bladder is empty or half empty, the procedure is prohibited, as the risk of consequences increases;

What could be the consequences?

When a cystostomy is installed correctly and used correctly, as a rule, there are no side effects. But the risk of complications cannot be excluded. Practicing urologists have described the following possible pathological reactions and conditions:

Allergy to tube material.
The incision site is bleeding.
The wound is rotting.
The intestines are damaged.
The bladder becomes inflamed.
The tube pulls out spontaneously.
The place where the tube is attached is irritated.
The patient may stop urinating on his own. The ability to urinate atrophies. The body does not strain; the tube does the work for it. Therefore, you should try to urinate yourself within a week after cystostomy.
Urine flows into the peritoneum.
The tube becomes clogged with blood and mucus.
The stoma hole closes.
Blood in the urine after cystostomy.
The walls of the bladder are damaged.
Suppuration around the cystostomy. Mucus or pus on the wound indicates infection. If there is no systemic inflammation, the suppuration is treated with antiseptics.

Puncture of a kidney cyst is an operation carried out in accordance with all the necessary rules for carrying out interventions in the human body. The procedure is performed only in a clinical setting, after which the patient remains in the hospital for 3 days under the supervision of medical personnel. Usually, after this therapy, the patient recovers quickly and safely.

During the rehabilitation period, an increase in body temperature and swelling in the puncture area may be observed, which quickly disappear. Since the entire process is controlled by an ultrasound machine, miscalculations are excluded - puncture of the pelvis, large blood vessels. However, complications can still occur:

bleeding into the renal cavity;
opening of bleeding into the cyst capsule;
the onset of purulent inflammation due to infection of the cyst or kidney;
organ puncture;
violation of the integrity of nearby organs;
allergy to sclerosing solution;
pyelonephritis.

IMPORTANT! If the patient has polycystic disease or a formation larger than 7 cm, the puncture is considered ineffective.

Classification:
Unilateral: for chronic pyelonephritis, renal artery stenosis, long-term thrombosis of the renal veins. The differential diagnosis takes into account renal hypoplasia.
Bilateral: for chronic glomerulonephritis, diabetic nephropathy, nephrosclerosis, other systemic diseases: less often for bilateral chronic pyelonephritis.

Clinical manifestations: end-stage chronic nephritis with renal failure; rapid fatigue, poor exercise tolerance, shortness of breath with pleural effusion and edema, anemia are often observed. With bilateral atrophy, hemodialysis is necessary.

Diagnostics:
Anamnesis.
Laboratory tests: simple general blood test; urine culture and microscopy of urinary sediment, 24-hour urine analysis, blood creatinine level; determination of creatinine clearance.
Ultrasonography. > Ultrasound data:
Disproportionately small kidney sizes. (When one kidney atrophies, as a rule, there is a compensatory increase in the opposite kidney.)
Thinning of the parenchyma.
Increased echogenicity of the parenchyma.
Blurred contours of the organ. Sometimes the kidney can only be visualized due to the presence of cortical cysts (cystic degeneration of the medullary pyramids or secondary retention cysts).

Accuracy of ultrasound diagnostics: The diagnosis can be made if the kidney is visualized and is disproportionately small. At the final stage of the disease, there is no need for histological confirmation of the diagnosis and, therefore, for percutaneous biopsy.

Bladder tamponade

Clinical manifestations: anuria, possible pain and tenderness in the lower abdomen. With prolonged tamponade with stagnation of urine, colicky pain occurs. Diagnostics:

History and examination: palpable mass in the lower abdomen (full bladder). The patient is asked about a possible inciting event (renal biopsy, bladder aspiration, etc.).
Ultrasound: Can also be used to guide percutaneous aspiration.
Cystoscopy. Ultrasound data:
Full bladder.
High-intensity internal echoes from clotted blood (eg, bladder aspiration, catheterization), debris, stone, or tumor are often detected.
Ultrasound diagnostic accuracy: Ultrasound can reliably diagnose bladder tamponade. The use of other diagnostic methods is required only to determine the cause of tamponade.

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As is known, the extensive spread of a bladder tumor makes radical treatment impossible, and the main goal of palliative treatment is to reduce or completely eliminate the painful symptoms of the disease, i.e. to improve quality of life indicators.

Palliative treatment methods:

1. Palliative surgical interventions
2. Radiation therapy
3. Chemotherapy
4. Immunotherapy

The main clinical syndromes during the progression of bladder cancer (BC):

1. Anemia
2. Intravesical obstruction syndrome
3. Chronic renal failure
4. Chronic pain syndrome

Thus, therapeutic measures against the background of the main methods of influence will also be aimed at combating pain, hematuria, acute urinary retention, blockade of the upper urinary tract, and paravesical phlegmon.

Those. the nature and extent of palliative care will be dictated by the most predominant clinical syndromes requiring emergency treatment.

Emergency conditions and their characteristics

Emergency conditions:

1. Hematuria
2. Bladder tamponade
3. Acute urinary retention
4. Blockage of the upper urinary tract (hydronephrosis)
5. Pain syndrome
6. Paravesical phlegmon

The appearance of blood in the urine (hematuria), as a rule, is the first symptom that forces the patient to consult a doctor and suspect the presence of a bladder tumor.

In the early stage of the disease, hematuria may not cause much concern and sometimes it is enough to prescribe hemostatic agents (nettle decoction, dicinone) to compensate for blood loss and stop bleeding.

Two symptom complexes can determine the urgency of the situation and the need for emergency medical care for profuse hematuria - acute anemia and bladder tamponade. Intense bleeding that is not controlled by conservative treatment methods leads to blood loss, hypovolemia and anemia.

Coagulation of blood spilled into the lumen of the bladder may be accompanied by the formation of clots that can cause bladder tamponade. If this situation occurs, it is necessary to resort to surgical treatment.

The scope of surgical intervention will be determined by the location of the tumor and the extent of the process. To do this, a high section of the bladder is performed, followed by its revision, freeing the bladder cavity from clots and restoring the passage of urine.

In case of limited cancer of the bottom and body of the bladder, resection of the bladder is performed; in case of infiltration of the ureteric opening, resection of the intramural part of the ureter is performed, followed by neoimplantation into the bladder.

In case of total damage to the bladder or the location of the tumor in the area of the bladder triangle, the possibility of the need for cystectomy, a technically difficult and traumatic operation for the patient, cannot be excluded.

Cystectomy ends with bilateral ureterocutaneostomy, since increasing the volume of the operation due to the formation of an artificial reservoir for urine, given the urgency of the operation, can have a fatal outcome.

If the bladder tumor is unresectable, attempts are made to stop the bleeding with palliative measures - electrocoagulation of the tumor, ligation of both internal iliac arteries.

In specialized medical institutions, it is possible to use endovascular interventions followed by embolization of the internal iliac arteries, under angiography control. The advantage of embolization is the possibility of occlusion of the peripheral arterial bed, which eliminates the development of collaterals.

Also, the advantage of endovascular intervention is the ability, through catheterization of one of the vessels, to carry out a regional infusion of hemostatic and cytostatic drugs, against the background of which it is possible to stop ongoing bleeding.

Embolization is carried out by transfemoral catheterization according to Seldinger, selective insertion of a catheter into the internal iliac artery on one or both sides and under visual control by occlusion of all peripheral vessels.

Bleeding from the bladder neck can be established using a Foley balloon catheter: after inserting the catheter into the bladder and inflating the balloon, the outer end is fixed in a taut position to the thigh, which provides compression of the tumor. You can also use a tight tamponade of the bleeding tumor with a gauze pad to stop bleeding.

In case of disturbance of the outflow of urine associated with germination of the ureteric orifices, their infiltration and leading to the development of ureterohydronephrosis and azotemia, the patient is advised:

Percutaneous nephrostomy;
ureteral stenting;
nephrostomy placement;
excretion of the ureteric orifices onto the skin.

In case of complete urinary retention, the optimal method of restoring urinary diversion is catheterization of the bladder with an elastic catheter. If it is impossible to install an elastic catheter, it is possible to perform a trocar epicystostomy or create a suprapubic fistula. A rubber Foley catheter is inserted into the bladder through the trocar and, after filling the balloon, it is left to drain the bladder and drain urine.

Tumor growth into the pelvic organs and compression of the nerve trunks is accompanied by persistent pain, leading to the need to use analgesics and narcotics.

The principles of medicinal treatment of pain syndrome are outlined above. It is also possible to use conductive novocaine blockades through the obturator foramen according to Stuckey, presacral blockade according to A.V. Vishnevsky, epidural denervation, resection of the presacral nerve plexus.

Although the modern development of pharmacotherapy reduces this direction to almost a minimum. Also, carrying out this kind of manipulation requires good skill. In case of metastatic lesions of the skeletal bones, short courses of local irradiation can be used to relieve pain.

Extraperitoneal perforation of the bladder develops in patients with advanced endophytic, infiltrating tumor due to its spontaneous or in the case of radiation disintegration. A defect in the bladder wall causes urine to leak into the peri-vesical cellular space, which is complicated by the development of paravesical phlegmon.

In this case, the optimal method of palliative care would be resection of the wall of the bladder with a disintegrating tumor and suturing of the post-resected defect.

The operation for paravesical phlegmon has two goals: urine diversion and drainage of the perovesical cellular space.

The most effective way to divert urine is an epicystomy through a “healthy” wall without signs of visible tumor invasion. When a tumor disintegrates in the area of the vesical triangle, the only possible way to divert urine to the outside is bilateral ureterocutaneostomy.

Drainage of the paravesical tissue through the anterior abdominal wall ensures outflow from the upper parts of the retropubic space and prevesical tissue. The peri-vesical tissue, located deep in the pelvis, should be drained through the obturator foramen.

After providing primary palliative care, patients are further recommended to undergo radiation therapy with single single dose (SOD) 1.8-2.5 Gy, total focal dose (SOD)- 60-70 Gy.

Contraindications to radiation therapy are compression of the ureters, acute pyelonephritis, the presence of multiple metastases, suppression of hematopoiesis, and severe general condition of the patient.

For chemotherapy, the most commonly used cytostatics are adriamycin, thioteph, mitomycin C, cisplatin, methotrexate, vinblastine, 5-Fluorouracil. The standard treatment regimen currently is a combination of 3-4 drugs based on cisplatin and methotrexate.

The most commonly used MVAC scheme is:

Methotrexate 30 mg/m2, intravenously, on days 1, 15, 22,
Vinblastine 3 mg/m2, intravenously, on days 2, 15, 22,
Adriamycin 30 mg/m2, intravenously, on day 2,
Cisplatin 70 mg/m2, IV, on day 2.

The interval between courses is 28 days. At least 2-3 courses. The effectiveness of chemotherapy for disseminated bladder cancer is about 50-70% and its use in a palliative mode if the patient is in good condition should not be neglected by the attending physician.

Novikov G.A., Chissov V.I., Modnikov O.P.

Bladder tamponade is a pathological condition in which the bladder cavity is completely filled with blood clots. This condition is considered by doctors as an emergency, because in connection with it, urination disorders develop, and sometimes acute urine retention.

Why is it developing?

Bladder tamponade can be a consequence of diseases of the genitourinary system, as well as the result of injuries. The main reasons are:

upper urinary tract injuries;
neoplasms of the upper urinary tract;
bladder neoplasms;
varicose veins of the urinary reservoir and prostate gland;
damage to the prostate capsule due to the capsule rupturing.

Bladder cancer is a common cause

Development mechanism

There is constant pressure on the muscle that relaxes the bladder, as well as on the neck of the bladder. It is formed due to the fact that it is necessary to overcome infravesicular blockage. Changes in pressure inside the bladder and a large volume of the prostate gland create conditions that lead to capsule rupture. As a result, hematuria occurs.

Symptoms

Based on determining the volume of blood in the bladder, the degree of blood loss is determined. Urine contains fresh or altered blood impurities. It is worth considering that tamponade of the urinary reservoir involves bleeding. The capacity of the bladder in a male is about 300 milliliters, but in fact the volume of lost blood is much larger.

Therefore, a sick person has all the signs of blood loss:

pale and moist skin;
heartbeat;
weakness and apathy;
dizziness;
increase in heart rate.

The main complaints of a patient with tamponade will be pain in the area of the urinary reservoir, inability to urinate, painful and ineffective urge, dizziness, blood in the urine.

Anemia is one of the complications of the pathological condition

How to diagnose?

Bladder tamponade is determined based on complaints and questioning. As a rule, the doctor finds out that there have already been cases of blood in urine. On examination, one notices pronounced pain when pressing in the pubic area, and the patient’s pale and unhealthy appearance.

There is blood in the urinary fluid. When examining men with a finger through the rectum, the doctor identifies a prostate gland that is larger than normal size.

The attending physician must prescribe blood and urine tests. In a general blood test, a decrease in the level of hemoglobin and erythrocyte elements is observed. There is also a pronounced increase in the level of leukocytes in the blood, a shift in the leukocyte count to the left and a high level of erythrocyte sedimentation rate. This happens due to the inflammatory process in the bladder.

In a biochemical blood test, the level of creatinine and uric acid increases. This is explained by the fact that against the background of acute urinary retention and prolonged tamponade, the cleansing ability of the kidneys decreases.

To diagnose tamponade, ultrasound examination of the bladder and prostate gland, as well as the upper urinary tract and kidneys, is used. On an ultrasound, you can see an enlarged prostate due to an adenoma. Blood clots in the form of elements of different echogenicity are observed in the urine reservoir.

Using ultrasound, it is possible to predict quite accurately the amount of blood that is in the cavity of the bladder. But examining the kidneys allows you to diagnose blockage of the urinary tract above the urine reservoir itself.

On ultrasound, this obstruction will be visible as expansion on both sides. The pyelocaliceal system and ureters expand. This type of diagnosis also identifies neoplasms if they are present.

Placing a catheter does not solve the problem, as it immediately becomes clogged with blood clots.

Treatment

Treatment measures are operational in nature. There are urgent and delayed surgical treatment. Urgent consists of revision of the urine reservoir and removal of the adenoma.

Hemostatics are drugs used for bleeding of various types.

But delayed treatment involves clearing the bladder of blood through the urethra in parallel with antibiotic and hemostatic therapy. Replacement of lost blood is also used. If the bleeding has stopped, then there is time for a full examination and delayed intervention. Tamponade is a very dangerous condition and requires immediate treatment. At the first signs, consult a doctor.

Bleeding is the most common (up to 80%) complication of kidney cancer. Usually hematuria occurs without warning and occurs without pain. Blood clots, passing through the ureter, acquire a worm-like shape and can clog its lumen, which is clinically manifested by lower back pain and attacks of renal colic.
To clarify the source of bleeding, it is necessary to perform cystoscopy and chromocystoscopy during hematuria.
Emergency therapeutic cystoscopy is aimed at eliminating bladder tamponade. The catheterization of the ureter performed in this case eliminates blood clots, restoring the passage of urine. If cystoscopy is ineffective, a cystostomy is necessary to remove blood clots and drain urine from the upper urinary tract.
With bladder cancer, massive bleeding lasting from several hours to a day is often observed. Sometimes even small benign papillomas serve as a source of massive, life-threatening bleeding. Continued hematuria leads to a serious complication such as bladder tamponade. Hematuria manifests itself as pain over the womb and urine stained with blood. The resulting blood clots cause painful dysuria or urinary retention.
The main diagnostic method for hematuria and bladder tamponade is cystoscopy. It allows you to determine the presence of a tumor, its growth, location, extent, and source of bleeding.

Emergency medical care

In this situation, emergency treatment measures include transurethral electrocoagulation of the source of bleeding, destruction and removal of blood clots and accumulated urine through the natural urinary tract. If it is impossible to carry out the above measures due to difficult access to the tumor, its decay or large size, transvesical electrocoagulation, suturing of the bleeding area or electroresection of the bladder wall with the mandatory use of a hemostatic therapy complex is indicated.
Disturbance of urine outflow in bladder cancer, it is caused by compression of the ureteral orifice by the growing tumor. Clinically, this is expressed by attacks of renal colic, a feeling of tension and heaviness in the lumbar region. When the tumor is localized in the neck of the bladder, the internal opening of the urethra becomes “jammed,” which is accompanied by attacks of radiating pain in the perineum.
Emergency care is aimed at diverting urine from the upper urinary tract through ureteral catheterization or nephrostomy.
Violation of the outflow of venous blood and lymph from the lower extremities occurs as a result of germination or compression of vascular formations in the paravesical region. These disorders are further aggravated by metastases to intrapelvic regional lymph nodes and are clinically manifested by edema of the lower extremities, pain in the pelvis and perineum. A vesicovaginal or vesico-rectal fistula is formed when bladder cancer grows into neighboring organs. This complication is accompanied by the release of feces from the vagina or liquid feces through natural routes and the development of an ascending infection of the urinary system. With fistulas, the injected dye (methylene blue) is released from the rectum or vagina. Emergency care in these cases is aimed at alleviating the patient's condition. For excruciating pain, in addition to analgesics (narcotics), novocaine blockade through the obturator foramen, epidural anesthesia or presacral anesthesia are used. A sigmostoma is applied to drain feces in case of intestinal fistulas and internal interorgan fistulas. The bladder is constantly washed with antiseptic solutions. With ascites, fluid evacuation from the abdominal cavity is mandatory.