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Point-of-Care Ultrasound for Real-Time Assessment of Bladder Clot Burden to Guide Management of Gross Hematuria: A Case Series
Orly Guerra, MD, Igor Sorokin, MD.
University of Massachusetts, Worcester, MA, USA.
Introduction: Gross hematuria with clot retention is a common urologic emergency requiring manual bladder irrigation or operative clot evacuation. Assessment of intravesical clot burden relies on physical examination and catheter output, while formal ultrasonography may be delayed by hours. Point-of-care ultrasound (POCUS) offers a rapid bedside alternative for real-time clot visualization with potential to directly inform management.
Objective: To evaluate the feasibility and clinical utility of resident-performed bedside POCUS for assessment and serial monitoring of bladder clot burden in gross hematuria.
Methods: We conducted a retrospective case series as part of a quality improvement initiative (IRB exemption obtained) at a single academic institution. Patients with gross hematuria and suspected clot retention who underwent bedside bladder POCUS performed by urology residents were included. Ultrasound characterized clot burden, intravesical distribution, and interval response to manual irrigation via pre- and post-irrigation imaging. Clinical utility was defined as POCUS findings that directly influenced the decision to continue bedside irrigation versus escalation to operative intervention.
Results: Ten patients underwent resident-performed bedside bladder POCUS for clot assessment. Intravesical clot was successfully visualized in all cases. POCUS enabled real-time clot localization and serial assessment before and after manual irrigation. Notably, two patients presented with clot retention following robotic simple prostatectomy; in both cases, POCUS guided complete bedside clot evacuation and averted return to the operating room. In several additional cases, interval clot clearance on POCUS supported continuation of bedside management and avoidance of operative intervention. Resident-performed POCUS reduced reliance on formal radiologic imaging and provided immediate clinical feedback. All studies were performed without complication.
Conclusions: Resident-performed POCUS is a feasible and clinically valuable modality for real-time assessment of bladder clot burden. Its integration may enhance bedside decision-making, reduce formal imaging dependence, and support point-of-care billing. These findings advocate for structured POCUS training within urology residency curricula.
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