PPF77 Staying in the hospice: managing clot retention with a small-bore ascitic drain and dual-catheter irrigation
Year: 2026
Type: conference-paper
Study design: Case Report
Abstract: Background Clot retention is a recognised urological emergency, but in hospice care standard interventions (three-way catheterisation, surgical evacuation) may be impractical or inconsistent with patient preferences. Small-bore ascitic drains are rarely described for suprapubic urinary drainage, and irrigation is seldom attempted outside acute hospital settings. This case highlights both an innovative use of a Rocket® Safety Drain for suprapubic bladder drainage and a dual-catheter irrigation technique to relieve refractory clot retention in a hospice. Methods A 75-year-old man with advanced prostate carcinoma developed gross haematuria and urinary retention during hospice admission. Conventional urethral catheterisation failed due to anatomical distortion, and cystoscopy confirmed that a three-way catheter could not be placed. Following informed consent, a small-bore suprapubic catheter (Rocket® Safety Drain) was inserted in the hospice alongside a urethral Foley catheter. Results Hydraulic irrigation was achieved by instilling sterile water via the urethral catheter and allowing passive drainage through the suprapubic catheter. This generated turbulence that mobilised obstructive clots, immediately relieving pain and bladder spasms. Continuous suprapubic irrigation maintained patency with only occasional manual flushing required. No complications occurred. Symptom control remained excellent, hospital transfer was avoided, and the patient died peacefully in the hospice ten days later. Conclusions This case demonstrates that small-bore ascitic drains can be adapted for suprapubic bladder access, and combined with dual-catheter irrigation to provide effective symptom relief in clot retention at the end of life. Such pragmatic, minimally invasive approaches expand the options available to palliative care teams, allowing urgent urological symptoms to be managed within the hospice while respecting patients’ care preferences.
Source: BMJ Supportive & Palliative Care
Authors: Katie Bland, Luke Feathers, David Wenzel
Institution: University of Leicester
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7140834288