Case report: Can fibrinolytics effectively manage gross hematuria and clot retention in an elderly patients, leading to the diagnosis of lymphoma?

A 77-year-old man presented with severe gross hematuria and extensive urinary tract clot retention unresponsive to catheterization and irrigation. CT showed clots throughout the upper and lower tracts; labs revealed pancytopenia and elevated creatinine. Bilateral nephrostomies with multiple Alteplase instillations dissolved clots, restored urinary flow, and normalized renal function. Bone marrow biopsy confirmed B-cell lymphoma. This case highlights fibrinolytic therapy as a minimally invasive option for clot retention and the importance of multidisciplinary evaluation in uncovering malignancies presenting with complex urologic emergencies.