016 Evaluation and Management of Hematuria

Question 1

Microscopic hematuria (MH) is defined by the AUA guidelines as __, identified on one or more occasions on urine microscopy. Urine dipstick testing is insufficient for the diagnosis of MH.

Answer 1

Microscopic hematuria (MH) is defined by the AUA guidelines as THREE OR MORE RBCs/HPF, identified on one or more occasions on urine microscopy. Urine dipstick testing is insufficient for the diagnosis of MH.

Question 2

MH is quite common, with a prevalence of approximately __ of adults, varying according to the characteristics of the population.

Answer 2

MH is quite common, with a prevalence of approximately 6.5% of adults, varying according to the characteristics of the population.

Question 3

Malignancy has been detected in approximately 3.5% of patients evaluated for asymptomatic MH. The risk of malignancy diagnosis is greater in patients with __, __ gender, and/or __, and lower in absence of these risk factors.

Answer 3

Malignancy has been detected in approximately 3.5% of patients evaluated for asymptomatic MH. The risk of malignancy diagnosis is greater in patients with HIGHER DEGREES OF HEMATURIA, MALE gender, and/or RISK FACTORS FOR MALIGNANCY, and lower in absence of these risk factors.

Question 4

Evaluation of adults with microscopic hematuria includes a __ and __, __, and __ for all patients.

Answer 4

Evaluation of adults with microscopic hematuria includes a HISTORY and PHYSICAL EXAMINATION, RENAL FUNCTION TESTING, and UPPER TRACT IMAGING for all patients.

Question 5

__ is recommended in the evaluation of asymptomatic MH for patients 35 years of age or older and/or those with risk factors for malignancy.

Answer 5

WHITE LIGHT CYSTOSCOPY is recommended in the evaluation of asymptomatic MH for patients 35 years of age or older and/or those with risk factors for malignancy.

Question 6

__ is the preferred imaging modality for the evaluation of hematuria.

Answer 6

CT UROGRAM is the preferred imaging modality for the evaluation of hematuria.

Question 7

Urine cytologic examination and biomarkers ARE/ARENOT indicated in the initial evaluation of asymptomatic MH.

Answer 7

Urine cytologic examination and biomarkers ARE NOT indicated in the initial evaluation of asymptomatic MH.

Question 8

Patients with a negative complete evaluation can be released from care if subsequent urinalyses confirm resolution of MH. Reevaluation should be considered in patients with __ and those with an incomplete initial evaluation.

Answer 8

Patients with a negative complete evaluation can be released from care if subsequent urinalyses confirm resolution of MH. Reevaluation should be considered in patients with PERSISTENT/RECURRENT MH and those with an incomplete initial evaluation.

Question 9

Oxazaphosphorine chemotherapeutic agents have been linked to the development of hemorrhagic cystitis through exposure of the metabolite __ to the urothelium.

Answer 9

Oxazaphosphorine chemotherapeutic agents have been linked to the development of hemorrhagic cystitis through exposure of the metabolite ACROLEIN to the urothelium.

Question 10

__ may be used as a first-line intravesical therapy for hemorrhagic cystitis in patients without renal dysfunction.

Answer 10

ALUM may be used as a first-line intravesical therapy for hemorrhagic cystitis in patients without renal dysfunction.

Question 11

__ is a highly effective form of intravesical therapy for hemorrhagic cystitis. A __ should be obtained before therapy to ensure no vesicoureteral reflux.

Answer 11

FORMALIN is a highly effective form of intravesical therapy for hemorrhagic cystitis. A CYSTOGRAM should be obtained before therapy to ensure no vesicoureteral reflux.

Question 12

__ has been associated with response rates of 80% to 100% for patients with hemorrhagic cystitis.

Answer 12

HBOT has been associated with response rates of 80% to 100% for patients with hemorrhagic cystitis.

Question 13

__ represents the most common cause of GH in men older than 60 years.

Answer 13

BPH represents the most common cause of GH in men older than 60 years.

Question 14

__ may be used for BPH-related GH, with potential improvement having been noted within weeks after instituting therapy.

Answer 14

5-ALPHA REDUCTASE INHIBITORS may be used for BPH-related GH, with potential improvement having been noted within weeks after instituting therapy.

Question 15

__ may be effective for patients with locally advanced prostate cancer with GH.

Answer 15

ANDROGEN DEPRIVATION may be effective for patients with locally advanced prostate cancer with GH.

Question 16

__and/or __ represent salvage options for management for patients with refractory hematuria, pending clinical status.

Answer 16

ANGIOEMBOLIZATION and/or URINARY DIVERSION represent salvage options for management for patients with refractory hematuria, pending clinical status.

Question 17

__ should be suspected with blood at the meatus and/or initial hematuria.

Answer 17

URETHRAL BLEEDING should be suspected with blood at the meatus and/or initial hematuria.

Question 18

A concern for traumatic urethral injury should prompt __.

Answer 18

A concern for traumatic urethral injury should prompt RETROGRADE URETHROGRAM.

Question 19

Urinary findings suggestive of a glomerular or tubulointerstitial medical renal disease include the presence of __ in the urinary sediment, __, and __.

Answer 19

Urinary findings suggestive of a glomerular or tubulointerstitial medical renal disease include the presence of RBC CASTS in the urinary sediment, DYSMORPHIC RBCs, and PROTEINURIA.

Question 20

In patients with GH after a recent renal procedure, expeditious __ should be considered to allow for the diagnosis and management of renal AVM.

Answer 20

In patients with GH after a recent renal procedure, expeditious ANGIOGRAPHY should be considered to allow for the diagnosis and management of renal AVM.