AMH Flashcards
Definition of AMH:
no symptoms, greater than 3 RBCs per high power field on microscopy. (Urine dipstick positive for heme not adequate)
What is the sample collection for male and female?
both are clean catch midstream. with men, you wipe the meatus or retract the foreskin. with women you spread the labia and wipe. (some require catheterized specimen–> obese, elderly, mentally unstable)
How many positive micro UA is sufficient for a work up?
just one.
What are the risk factors for urologic malignancy?
smoking, males, age>35, occupational exposures, history of : gross hematuria, pelvic radiation, chronic UTI, alkylating chemo, chronic indwelling.
What are the top 3 benign causes of AMH?
BPH, UTI, and Stones (other causes include obstructions, renal disease, benign tumors–> bhp, renal cysts, polyps)
What are some obvious causes of a positive micro UA?
uti, strenuous exercise, sex, trauma, periods
Should you send for a culture in the case of AMH?
yes!
What two things to bladder cancer and UTIs have in common?
positive leukocytes, positive blood
Can a blood thinner cause AMH?
yes
If there is a negative culture, what else should be included in your workup?
creatinine. it will help r/o a renal cause of the disease. If renal disease is noted then nephrology and urology eval is needed.
What further eval may be needed?
imaging (always), cystoscopy (almost always), cytology (not initially)
What is the gold standard for imaging of AMH?
CT with and without contrast
What is good of evaluation of stones?
IVP
What is good for the evaluation of masses?
U/S
What can the non-contrast CT tell you?
stones, hydronephrosis, fat containing lesions
What does the arterial phase tell you?
tumors, inflammatory lesions
What does the venous stage tell you?
scarring
What does the excretory phase tell you?
pyelogram, ureters, bladder
Who can’t have CT with contrast?
pregnant, contrast allergy (give them some benadryl), renal insufficiency (could put them into renal failure)
What is retrograde pyelography?
A scope is put into the bladder, and you inject contrast. It goes up into the upper collecting systems. Safe even with renal insufficiency or contrast allergy.
What is the best way to R/O bladder cancer?
Cystoscopy. Imagine may miss many bladder tumors depending on how full the bladder is.
Who is recommended to have a cystoscopy?
all patients older than 35 years old, or those who have a risk factor and hx for risk of malignancy.
What are the AUA guidelines for AMH
3 negative microscopic Uas need to be done on every patient with one positive dipstick for a rule out. After a negative AMh eval, then follow up with UAs yearly. After two negative UAs, then no further are needed for AMH. If persistent, then follow up after 3-5 years.
