Haematuria

Question 1

What are the causes of urological haematuria?

Answer 1

PPONTTTTHIS

• Period
• Prostate (prostatits, CaP, BPH)
• Obstructive uropathy
• Nephritis (IgA, interstitial)
• Trauma
• Tumour
• TB
• Thrombosis (renal infarct, renal vein thrombosis)
• Haematological (anticoags, bleeding diathesis, sickle cell)
• Infection/inflammation
• Stones

Question 2

DDx urological haematuria?

i.e. non blood causes red urine

Answer 2

• Drugs causing red urine

- False +ve dipstick (myoglobinuria)

Question 3

Which drugs can cause red urine?

Answer 3

• Pyridium
• Nitrofurantoin
• Rifampicin
• Ibuprofen
• Phenytoin
• L-DOPA
• Chloroquine
• Beetroot

Question 4

Why is haematuria clinically significant?

Answer 4

• 10-20% patients with gross haematuria have urological malignancy.
• Rarely sufficient blood loss to cause haemodynamic instability.

Question 5

Hx features in haematuria?

Answer 5

• Initial / terminal / total?
• PU? Clots?
• Painful or painless?
• Infective Sx? LUTS?
• Trauma? / Surgery?
• Anticoagulation?
• PHx urological conditions?
• SMoking?
• DM?

Question 6

Exam features in haematuria?

Answer 6

• PR/BP/Temp
• Abdo (massess, tenderness, ?bladder palpable)
• Genital (urethral tumour)
• DRE

Question 7

Ix in haematuria?

Answer 7

• FBE: Hb
• Coags
• UEC: Cr
• MSU for MCS: confirm haematuria, ?infection, glomerular v non-glomerular
• Imaging: CT IVP
• Cystoscopy

Question 8

Management of haematuria with significant bleeding / clots / retention?

Answer 8

• 3 way IDC (22 - 24F)
• manual bladder washout (2-3L)
• continous bladder irrigation (stop new clots)
• cease anticoags if safe
• ?need transfusion
• refer urology