Transient Gross Hematuria Following Urethral Catheterization in a Patient with Severe Intravesical Prostatic Protrusion: A Case Report from a Resource-Limited Setting
DOI:
https://doi.org/10.59141/-.v8i2.473Keywords:
Gross hematuria, intravesical prostatic protrusion, urethral catheterization, benign prostatic hyperplasia (BPH), case reportAbstract
Background: Gross hematuria in elderly men frequently raises suspicion of urological malignancy. However, benign anatomical conditions such as severe intravesical prostatic protrusion (IPP) may predispose patients to procedure-related bleeding, particularly following urethral catheterization. Objective: To describe transient gross hematuria following urethral catheterization in a patient with severe intravesical prostatic protrusion and to emphasize the importance of chronological clinical assessment in differentiating benign procedure-related bleeding from possible malignancy. Methods: This study is a descriptive single-patient case report. An 85-year-old man presented with acute urinary retention complicated by septic shock and acute kidney injury. Gross hematuria occurred immediately after urethral catheterization. Clinical evaluation included laboratory investigations and transabdominal ultrasonography. Results: Ultrasonography revealed severe benign prostatic enlargement (estimated volume 176 mL) with grade 3 IPP measuring 2.04 cm. The hematuria resolved spontaneously within 24 hours without clot formation or recurrence. No intravesical mass or hydronephrosis was identified. Conclusion: Severe IPP may predispose elderly patients to transient catheter-induced hematuria due to anatomical distortion and increased mucosal vulnerability. Recognition of this self-limiting presentation is particularly important in resource-limited settings to avoid unnecessary invasive investigations while maintaining appropriate oncologic vigilance.
Downloads
References
Barocas, D. A., Lotan, Y., Matulewicz, R. S., Raman, J. D., Westerman, M. E., Kirkby, E., Pak, L. J., & Souter, L. (2025). Updates to microhematuria: AUA/SUFU guideline (2025). The Journal of Urology, 213(5), 547–557. https://doi.org/10.1097/JU.0000000000004490
Billah, M. A., Monowar-UL-Haque, M., Akter, T., Rahman, M. M., Rashid, M. M., Rahman, M., & Kamal, M. (2024). Correlation of different grades of intravesical prostatic protrusion with uroflowmetry parameters in patients with symptomatic benign enlargement of prostate. Archives of Nephrology and Urology, 7(1), 1–8. https://doi.org/10.26502/anu.2644-2833073
Biswas, B. (2025). A comprehensive guide to biopsy contraindications and risk mitigation in clinical practice. Forever Shinings Publication.
Croghan, S. M., Hayes, L., O’Connor, E. M., Rochester, M., Finch, W., Carrie, A., Considine, S. W., D’Arcy, F., Nic an Riogh, A., Mahmalji, W., Elhadi, M., Thursby, H., Pearce, I., Modgil, V., Noweir, H., MacCraith, E., Madden, A., Manecksha, R., Browne, E., … Flood, H. D. (2022). A prospective multi-institutional evaluation of iatrogenic urethral catheterization injuries. Journal of Investigative Surgery, 35(10), 1761–1766. https://doi.org/10.1080/08941939.2022.2109226
European Association of Urology. (2025). EAU guidelines on non-neurogenic male lower urinary tract symptoms (LUTS). https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts
Gezmiş, C. T., Çilesiz, N. C., Kartal, V. H., Altan, M. K., Çakıroğlu, B., & Balcı, M. B. C. (2026). Correlation between intravesical prostatic protrusion and ejaculatory dysfunction after tamsulosin treatment in men with BPH. World Journal of Urology, 44, 180. https://doi.org/10.1007/s00345-026-06266-8
Hamza, B. K., Ahmed, M., Bello, A., Tolani, M. A., Awaisu, M., Lawal, A. T., Oyelowo, N., Abdulsalam, K. I., Lawal, L., Sudi, A., & Maitama, H. Y. (2021). Correlation of intravesical prostatic protrusion with severity of lower urinary symptoms among patients with benign prostatic hyperplasia. African Journal of Urology, 27, 4. https://doi.org/10.1186/s12301-020-00102-0
Harrison, G., Pennington, A., & Awad, K. (2024). Management of catheter-related urethral injuries in male children. Cureus, 16(12), e76405. https://doi.org/10.7759/cureus.76405
Jakus, D., Šolić, I., Jurić, I., Borovac, J. A., & Šitum, M. (2023). The impact of the initial clinical presentation of bladder cancer on histopathological and morphological tumor characteristics. Journal of Clinical Medicine, 12, 4259. https://doi.org/10.3390/jcm12134259
Lawton, J. D., Ortiz, N., Henry, A., Smith, C., Smith, R., & Rapp, D. E. (2024). Characterization and outcomes of iatrogenic urethral catheterization injuries. Urology Practice, 11(2), 385–393. https://doi.org/10.1097/UPJ.0000000000000502
Mathabe, K. M. (2020). The pathological features of prostate cancer in South African men: What is the prevalence of local invasion at diagnosis?
Meira, A. S., Lima, G. S., Figueira, A. L. G., Silveira, R. C. C. P., & Kusumota, L. (2024). Urinary catheterization and techniques for preventing hematuria: Integrative review. Acta Paulista de Enfermagem, 37, eAPE01272. https://doi.org/10.37689/acta-ape/2024AR00012722
Ngowi, B. N., Kimolo, M., Mbwambo, J., Bright, F., Mremi, A., & Mbwambo, O. J. (2024). Giant intravesical prostatic protrusion mimicking bladder carcinoma: Navigating diagnostic and management challenges. International Journal of Surgery Case Reports, 118, 109590. https://doi.org/10.1016/j.ijscr.2024.109590
O’Connor, E. M., Croghan, S. M., Baird, O., Fallon, J., Loughman, P., Esoof, J., Keenan, R. A., Ryan, J., Manecksha, R., D’Arcy, F., Purtill, H., Varma, R., Thursby, H., Matkowski, A., El Hadi, S., Mahmalji, W., & Giri, S. K. (2023). A prospective multi-institutional study using a novel safety valve for the prevention of catheter balloon inflation injury of the urethra. The Journal of Urology, 210(1), 179–185. https://doi.org/10.1097/JU.0000000000003449
Okedere, T. A., Idowu, B. M., & Onigbinde, S. O. (2023). Ultrasonographic intravesical prostatic protrusion in men with benign prostatic hyperplasia in Southwest Nigeria. Journal of the West African College of Surgeons, 13(2), 16–22. https://doi.org/10.4103/jwas.jwas_270_22
Oyibo, U. E., Nwagu, C. V., Osakpamwan, I. N., & Aku, J. (2023). Intractable haematuria due to giant prostatic hyperplasia in a resource-challenged centre: Between the devil and the deep blue sea. African Urology, 3(3), 131–133. https://doi.org/10.36303/AUJ.0103
Sandhu, J. S., Bixler, B. R., Dahm, P., Goueli, R., Kirkby, E., Stoffel, J. T., & Wilt, T. J. (2024). Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023. The Journal of Urology, 211(1), 11–19. https://doi.org/10.1097/JU.0000000000003698
Şenel, S., Özden, C., Aktaş, B. K., Gökkaya, C. S., & Paşalı, Ş. (2020). Giant median lobe hyperplasia of the prostate mimicking bladder tumor: A case report. Archives of Current Medical Research, 1(1), 38–40. https://doi.org/10.47482/acmr.2020.7
Szymkiewicz, S. (2025). Clinical significance, differential diagnosis and initial management of hematuria in emergency and outpatient settings. Renal Failure, 14, 15.
Widiasari, K. R., Wijaya, I. M. K., & Suputra, P. A. (2021). Diabetes melitus tipe 2: Faktor risiko, diagnosis, dan tatalaksana. Ganesha Medika, 1(2), 114.
Woldu, S. L., Ng, C. K., Loo, R. K., Slezak, J. M., Jacobsen, S. J., Tan, W. S., Kelly, J. D., Lough, T., Darling, D., van Kessel, K. E. M., de Jong, J. J., van Criekinge, W., Shariat, S. F., Hiar, A., Brown, S., Boorjian, S. A., Barocas, D. A., Svatek, R. S., & Lotan, Y. (2021). Evaluation of the new American Urological Association guidelines risk classification for hematuria. The Journal of Urology, 205(5), 1387–1393. https://doi.org/10.1097/JU.0000000000001550
Wu, M.-Y., Chang, J.-R., Lee, Y.-K., Lin, P.-C., & Tsai, T.-Y. (2022). The effect and safety of rapid and gradual urinary decompression in urine retention: A systematic review and meta-analysis. Medicina, 58(10), 1441. https://doi.org/10.3390/medicina58101441
Yildiz, A. K., Oktem, C., Keseroglu, B. B., Kacan, T., Ozgur, B. C., Doluoglu, O. G., & Karakan, T. (2024). A new scoring system to differentiate bladder cancer from intravesical prostatic protrusion in the bladder neck: BCa-IPP score. Current Medical Imaging, 20, e15734056241577. https://doi.org/10.2174/0115734056241577231023064014
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Muhammad Fadli, Welly Patanasalu
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aCreative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
