Some blood in the urine is expected after prostate surgery, but heavy or growing bleeding can block the catheter with clots or cause shock. Nurses watch the color of the urine, the flow through the catheter and the vital signs closely in the first days.
Key symptoms
- Bright red urine or urine with clots in the catheter bag
- Bladder spasms, lower belly pain or a strong urge to void
- Little or no urine draining, which suggests a blocked catheter
- Dizziness, weakness or feeling faint
What you find on exam
- Heart rate and blood pressure trends; look for rising pulse and falling pressure
- Urine color, clots and the flow in the catheter and irrigation line
- Distended or tender bladder above the pubic bone
- Skin color, capillary refill and urine output
Tests
- Hemoglobin and hematocrit, repeated over time
- Coagulation tests (PT, INR, aPTT) and platelet count
- Type and crossmatch if bleeding is heavy
- Bladder scan if the catheter may be blocked
Treatment basics
- Keep continuous bladder irrigation running fast enough to keep urine light pink
- Gently hand-irrigate the catheter to clear clots, per the order
- Keep the catheter secured with traction as ordered; do not reposition it alone
- IV fluids and blood transfusion for significant blood loss; hold anticoagulants
- Call the surgeon early; return to the operating room for ongoing bleeding
Red flags
- Bright red urine with clots that keeps getting worse
- Catheter not draining with a tense, painful bladder
- Fast pulse, low blood pressure or falling hemoglobin
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Sources: Open RN, Nursing Skills 2e (Chippewa Valley Technical College); NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.