Authors: Paula Vallecillo Encinas , Cristina Lombardia Gonzalez de Lera , Lucia Rodriguez Lozano , Ines Cividanes Uhagon , Miguel Lorenzo Sanz , Marina Fernandez Velicia

Abstract

Background: Nephrostomy tubes are frequently used to relieve upper urinary tract obstruction but may become blocked by blood clots, especially in patients with hematuria. Urokinase, a plasminogen activator, is approved for treating catheter blockages but is rarely used in the urinary tract.

Case Presentation: We report the case of a 78-year-old male with bilateral nephrostomies due to metastatic prostate cancer who developed right-sided nephrostomy blockage caused by clots. The patient also experienced acute kidney injury and severe anemia requiring transfusions. After conventional flushing failed, he was treated with intraluminal urokinase instillations (10,000 IU every 8 hours for 48 hours). This led to quick restoration of nephrostomy patency, resolution of hematuria, and clinical stabilization without the need for additional invasive procedures.

Conclusion: This case shows that intranephrostomy urokinase instillation can be an effective, minimally invasive option for managing clot-related nephrostomy tube blockage, especially in palliative or fragile patients where procedural risks are high.

Keywords: Urokinase; Nephrostomy; Blood clots; Prostate cancer; Case Report.