title: Simple, safe, and successful evacuation of severe organized clot retention using a catheter connected with wall suction: suction and fishing method.
abstract: OBJECTIVE
  To introduce a novel method to successfully remove organized hematoma. Endoscopic evacuation can be troublesome in some patients with a large amount of blood clots or organized hematoma.
  
  
  METHODS
  We retrospectively reviewed medical records of 15 patients who were treated with a so-called "suction and fishing method" for severe clot retention. A large-bore catheter connected with a wall suction unit was inserted into the bladder through the resectoscope sheath, and subsequently a large volume of urine retention and quite a substantial amount of soft clots were removed (suction step). After awhile, negative pressure could not work when the catheter met large and organized fragments of blood clots. In this situation, large blood clots hanging on the catheter tip were removed by gently removing the catheter (fishing step).
  
  
  RESULTS
  In all patients, clot retention was successfully managed with this method. Clot evacuation was performed without anesthesia in 9 patients when electrocauterization was not planned, and opioid analgesics were sufficient for pain control. In the other 6 patients, clot evacuation and fulguration were performed under anesthesia. Median time for clot evacuation was 20 minutes (range 5-55) and median estimated volume of clot evacuated was 200 mL (range 50-600). There was no procedure-related complication such as bladder rupture.
  
  
  CONCLUSIONS
  The suction and fishing method is a simple, safe, and successful way to evacuate severe organized clot retention. It can resolve intractable clot retention and rapidly relieve related symptoms without anesthesia.
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ho Song
authors.initials: HS
authors.lastname: Yu
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Ham
authors.forename: Yoon Soo
authors.initials: YS
authors.lastname: Hah
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Lee
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Jang
authors.forename: Kang Su
authors.initials: KS
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006406:Hematoma / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013396:Suction / Q000379:methods; D013927:Thrombosis / Q000628:therapy*; D001745:Urinary Bladder Diseases / Q000628:therapy*; D014546:Urinary Catheterization