Pilot study of alteplase (tissue plasminogen activator) for treatment of urinary clot retention in an in vitro model

Chad R. Ritch, Maria A. Ordonez, Zhamshid Okhunov, Juan Araujo, Rhonda Walsh, Vania Baudin, Daniel Lee, Ketan K. Badani, Mantu Gupta, Jaime Landman

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Introduction: The management of urinary clot retention and hematuria involves manual irrigation with sterile water or normal saline via a Foley catheter followed by continuous bladder irrigation. Irrigation may become difficult because of the formation of dense blood clots. Tissue plasminogen activator (t-PA/Alteplase) may be a useful pharmacological agent to improve the efficacy of manual irrigation of large, dense clots. The goal of the current study was to compare t-PA to sterile water for clot irrigation in an in vitro model. Materials and Methods: In vitro models of clot retention were created using 500-cc urinary leg bags each filled with 80 cc of unpreserved whole blood from a healthy volunteer. Each model was incubated at 25°C for 24 hours to allow clot formation. Four models each with 25mL solution of t-PA at concentrations of 2, 1, 0.5, and 0.25°mg/mL were evaluated and compared to a control (25°mL sterile water). Models were instilled with solution (t-PA or control) and incubated for 30 minutes at 37°C, and then irrigated with sterile water via 18F Foley by a blinded investigator. Three separate experiments were conducted, and statistical analysis was performed comparing various irrigation parameters. Results: Clot evacuation with 25°mL of t-PA at a concentration of 2°mg/mL (50°mg) was significantly easier (p≤ 0.05) and faster (p<0.05) than the sterile water control. The mean time for clot evacuation in this model was 2.7 minutes for t-PA solution 2mg/mL versus 7.3 minutes for the control (p<0.05). Compared to the control, irrigation with t-PA solution 2mg/mL also required less irrigant (180mL vs. 500mL) (p<0.05) for complete evacuation. There was a similar trend in efficacy for the lower doses of t-PA, but this was not statistically significant. Conclusion: In this in vitro study, a single 25mL instillation of t-PA solution 2mg/mL is significantly better than sterile water alone for clot evacuation. In vivo animal studies are pending.

Original languageEnglish (US)
Pages (from-to)1353-1357
Number of pages5
JournalJournal of endourology
Volume23
Issue number8
DOIs
StatePublished - Aug 1 2009
Externally publishedYes

ASJC Scopus subject areas

  • Urology

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