Mechanical suction: an effective and safe method to remove large and tenacious clots from the urinary bladder.

Objective: To describe an alternative technique for removing tenacious and chronic clots by applying stronger suction pressure through the cystoscope sheath in patients who had failed clot evacuation using the traditional Ellik evacuator.

Methods: In this method, either the 25-F cystoscope sheath or 26-F resectoscope sheath was directly attached with the tubing from centralized suction source, and moderate negative pressure (up to 250 mm Hg) was applied.

Results: This technique was used in 15 adult patients with clot retention. Average duration for clot retention was 36.5 hours (range 22-60 hours). All patients were rendered clot free in an average operative period of 88 minutes (range 60-120 minutes). At the end of the procedure, apart from punctuate hemorrhagic spots on the bladder mucosa, no complications were encountered.

Conclusions: Clots that are old, large, and tenacious can be effectively and safely evacuated by applying moderate suction pressure from central suction source directly through the cystoscope sheath.