Haematuria

Question 1

Types of haematuria?

Answer 1

Visible:
• Macroscopic
• Gross

Non-visible:
• Microscopic
• Dipstick haematuria
• Symptomatic or non-symptomatic (often an incidental finding), non-visible haematuria

Question 2

Symptoms of symptomatic, non-visible haematuria?

Answer 2

Lower urinary tract:
• Hesitancy
• Frequency 
• Urgency
• Dysuria

Upper urinary tract:
• Renal colic

Question 3

Main cause of frank haematuria?

Answer 3

Often a pathological reason; it is malignancy until proven otherwise, i.e: the aim is to rule out cancer

Benign - infection, stones (can damage mucosa), etc
Malignant
Trauma
Other

Question 4

When is microscopic haematuria significant?

Answer 4

If 3 or more RBCs are found on microscopy from 2/3 properly collected urinalysis specimens

Question 5

Causes of microscopic haematuria?

Answer 5

Often idiopathic

Could be a GU or UUT malignancy

Question 6

Risk factors for malignancy?

Answer 6

Age >40 years

Smoking, analgesic abuse (phenazocine?)

Occupational exposure to chemicals/dyes

PMH of gross haematuria, urologic disorder/disease, voiding symptoms, UTIs

Question 7

Types of inflammatory disorders that can occur in the urinary tract?

Answer 7

Urethritis, prostatitis, cystitis, ureteritis, pyelonephritis and glomerulonephritis

Question 8

How can tumours cause bleeding?

Answer 8

1. Formation of new blood vessels
2. Increased blood vessel density in the tumour
3. Abnormal vessels bleed more quickly
4. Invasion into the urinary tract

Question 9

Renal cell cancer triad?

Answer 9

Israel triad:
• Haematoma
• Kidney mass
• Pain

Question 10

Presentation of penile cancer?

Answer 10

Haematuria (if invading urethra)

Itching/burning under foreskin

Red indurated skin

Mass

Question 11

How can trauma cause haematuria?

Answer 11

Perirenal haematoma, etc

If the perlvicalyceal system is breached