[Use of Amplatz cannula through cystostomy]

Bladder tamponade is an uncommon complication of post-TURP bleeding and, for its resolution, it may require a long and complex process when conducted transurethrally.

From 2001 to 2011, 20 patients were treated endoscopically by transurethral combined use of Amplatz percutaneous suprapubic cannula. Blood clots were detected above the average size of 5 cm. The technique has required a transurethral access with resector, dissection and resection of clots. In cases where the techniquet has proved insufficient, an Amplatz cannula was introduced by suprapubic access. The resector allows controlling the technique and a constant irrigation, and is also necessary for the final evaluation of the clinical picture. The procedure has been completed with the application of a suprapubic catheter left in site for 24 hours, together with a transurethral one for 48 hours.

In all the cases that we treated, the condition was solved between 15 and 25 minutes, and the evacuation of blood clots was entirely performed. There were no complications. The final control by transurethral way allowed executing hemostasis in all cases. The post-TURP vesical tamponade can represent a dramatic event in terms of pain and alteration of renal function for patients with renal insufficiency. The combined technique, which might appear bloody, represents a valid alternative to the classic transurethral endoscopic technique, which still represents the gold standard in the case of small bleeding and not organized blood clots.

The use of a suprapubic approach with this technique allows for a rapid, efficient and secure resolution of, otherwise, a long and difficultly treatable disease as it is the case with bladder tamponade due to clots for non-neoplastic diseases.