Approach to Hematuria

Question 1

What is the chance of urologic malignancy with

1. Gross hematuria
2. Microscopic hematuria

Answer 1

1. 25%

2. 5%

Question 2

4 most common urologic causes of hematuria

Answer 2

Stones
Trauma
Tumor
Infections

Question 3

Gross, painless hematuria is ___ until proven otherwise

Answer 3

Malignancy

Question 4

Main risk factor for urothelial tumors

Answer 4

Smoking

Question 5

What is the first choice imaging for patients with gross hematuria?

Answer 5

CT IVP

Question 6

3 types of bladder cancer

Answer 6

Urothelial carcinoma (most common)
Adenocardinoma
Squamous cell carcinoma

Question 7

What does the tumor invade if it is stage

1. Ta
2. T1
3. T2

Answer 7

1. mucosal layer
2. lamina propria
3. detrusor

Question 8

Treatment of non-muscle invasive disease

Answer 8

Transurethral resection of lesion
Strongly consider mitomycin to prevent recurrence
Intravesical chemo if additional factors

Question 9

Bacille Calmette-Guerin

Answer 9

Only agent to demonstrate decreased progression of NMIBC

Question 10

Mitomycin

Answer 10

Reduces recurrence risk of NMIBC

Question 11

Treatment of muscle invasive bladder cancer

Answer 11

Radical cystectomy

+/- systemic chemo

Question 12

Typical triad of renal mass

Answer 12

Flank pain
Hematuria
Palpable mass
Uncommon now - mostly an incidental finding

Question 13

Most common type of malignant renal cell carcinoma

Answer 13

Clear cell RCC

Question 14

1st imaging test for renal colic

Answer 14

Plain x-ray
85% of stones are radio-opaque
Doesnt tell you about degree of obstruction though

Question 15

Calcium oxalate stones

Answer 15

Most common type of stones

Risk factors: dietary hyperoxaluria, hypercalciuria, dietary hypercalciuria

Question 16

Calcium phosphate stones

Answer 16

Second most common stone type

Often seen in patients with metabolic abnormalities

Question 17

Uric acid stones

Answer 17

Radiolucent on x-rays (cannot see), but you can see on CT

Risk factors: perisistent acidic urine, gout, excess dietary purine, chemo

Question 18

Struvite stones

Answer 18

Infection stones
Composed of Mg, ammonium phosphate, and calcium
Can only form if urine pH >8.0
Tend to form staghorn stones

Question 19

Extracorporeal shockwave lithotripsy

Answer 19

Indicated for a <2cm renal or ureteric stone
Stone is localized by x-ray
Repeated shocks targeted to gradually fragment stone
Fragments passed in urine