Haematuria

Question 1

Presentation of Bladder cancer

Answer 1

Haematuria: painless visible 85% of cases - non visible as well
Lower urinary tract symptoms: Storage LUTS of frequency / urgency / nocturia
Recurrent UTI
On examination: Mass in lower abdomen / above/infiltrating prostate on DRE
Fixed mass locally invasive, mobile mass better prognosis

Question 2

Investigation of haematuria

Answer 2

Flexible cytoscopy:
Office procedure, 5 minute job, 5% risk of UTI, fairly well tolerated
Can see if any abnormality - if there is, list for GA TURBT

Question 3

Imaging for haematuria

Answer 3

Varies from department to department, but as general rule of thumb:
USS KUB if low risk, less sensitive, but safest
CT Urogram is a lot of radiation and contrast, sensitive for upper tract

Question 4

Urine cytology for haematuria

Answer 4

Rarely requested now as results often equivocal
The idea is to detect CIS in a normal looking bladder

Question 5

Causes urological causes of persistent Non visible haematuria (NVH)

Answer 5

BPH, cancer (bladder, kidney, prostate), stone disease, infection (haemorrhagic cystitis)

Question 6

Less common urological causes of NVH

Answer 6

Radiation cystitis, urethral stricture, TB, Medullary Sponge Kidney, Cyclophosphamide cystitis

Question 7

Nephrological causes of NVH

Answer 7

IgA nephropathy, thin basement membrane disease, glomerulonephritis, vasculitis, HSP