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Visible haematuria complicated by clot retention — MSRA MCQ

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HardHematuriaVisible haematuria complicated by clot retentionMSRA

A 71-year-old man presents to his GP with 12 hours of painless dark-red visible haematuria and passage of several clots. For the past 5 hours he has been unable to pass urine and has worsening suprapubic discomfort. He has a palpable, tender bladder. He is afebrile, haemodynamically stable and has no loin pain. Urine dipstick is negative for nitrites and leucocytes. He has no history of urinary tract infection, recent instrumentation or known urological malignancy. What is the most appropriate immediate management?

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Correct answer: A — Arrange emergency hospital urology assessment for clot retention and bladder drainage or irrigation

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · C = shown as D · B = shown as E

This is acute clot retention: visible haematuria with clot passage, inability to void, a painful palpable bladder and progressive suprapubic discomfort. The immediate priority is relief of obstruction and control of ongoing intravesical clot formation, requiring emergency hospital assessment. Management may include urethral catheterisation, usually with a large-bore 3-way catheter when clots are present, and bladder irrigation. Suprapubic catheterisation should be avoided in visible haematuria. He also meets NICE criteria for a suspected cancer pathway referral because he is aged over 45 years with unexplained visible haematuria without evidence of UTI. However, this investigation follows—not replaces—management of the acute obstructive complication. A is therefore necessary subsequently but unsafe as the immediate action. B may contribute to later investigation but delays bladder decompression. C is inappropriate because suprapubic catheterisation is contraindicated in this context. D provides useful baseline tests but must not delay emergency management. ([nnuh.nhs.uk](https://www.nnuh.nhs.uk/publication/download/joint-trust-clinical-procedure-for-the-management-of-haematuria-v2/))

Reference: NICE NG12: Suspected cancer: recognition and referral — recommendations organised by site of cancer (Updated 2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer Clinical Procedure for the Management of Haematuria (Approved October 2024) — https://www.nnuh.nhs.uk/publication/download/joint-trust-clinical-procedure-for-the-management-of-haematuria-v2/