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Alteplase Instillation for Upper Urinary Tract Clot Dissolution

Ali Mahmoud1, Madeleine Manka2, Roy Lipworth2

  • 1School of Medicine, University of Texas Medical Branch, Galveston, Texas.

Journal of Endourology Case Reports
|August 8, 2020
PubMed

We report the first case of instillation of alteplase, a tissue plasminogen activator, to dissolve occlusive upper urinary tract blood clot. A 67-year-old Caucasian man with a solitary kidney became dialysis dependent because of upper urinary tract clot obstruction after ureteral stent placement for obstructing ureterolithiasis. After failure of more conservative measures, 10 mg of alteplase was instilled through nephrostomy tube daily for 2 consecutive days 30 minutes before manual irrigation with physiologic saline. After alteplase instillation, the occlusive blood clot dissolved with rapid improvement in urinary output and creatinine. Alteplase instillation through nephrostomy tube is a viable option to dissolve obstructing upper urinary tract blood clots.

Keywords:
imaginginstrumentationobstructionstentsurolithiasis

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