Objective: Retrospective evaluation of patients presented with haematuria andclot retention due to various etiologies and assessing the management outcomes in a tertiary care centre. Methods: Between 2011 to 2021, patients presented with retention of urine due to blood clots in emergency ward were included in the present study. After initial stabilisation of vital parameters, clot evacuation was performed under regional or general anaesthesia. Patients with active bleeding from bladder underwent fulguration of bleeding points. Post operatively continuous saline irrigation was started till urine became clear. Definitive management of the patients was done once patient was stabilised. Results: The mean patient age was 55 years (38-80 years) and mean duration of hematuria was 24 hours (8-96 hours). Males were more common sufferers than females (4:1).Of 418 patients, 397(90%) were managed by resuscitation with intravenous fluids, blood transfusion and emergency clot evacuation. The most common etiology for bladder clots was bladder tumour (39.23%) followed by prostatic bleed (25.11%) including benign prostatic hyperplasia and carcinoma prostate, renal and upper tract tumours, kidney stones, chylohematuria, urinary tract infection and rarely hemorrhagic cystitis. Conclusion: Initial resuscitation followed by emergency cystoscopy and clot evacuation is life saving procedure in patients presenting with gross hematuria with clot retention. Definitive management of causative factor can prevent further episodes of such painful and life threatening condition.