Haematuria

Question 1

Causes of visible haematuria (2)

Answer 1

20%-malignancy

80%-stones, infection, benign prostatic conditions

Question 2

Causes of painful haematuria (5)

Answer 2

infection/UTI

stones:

• renal
• bladder: pain relieved by lying down
• ureteric

papillary necrosis

haemorrhagic cystitis: from hydroxychloroquine

trauma

Question 3

Causes of painless haematuria (4)

Answer 3

cancer: RCC/TCC

GN

vigorous exercise

coagulation disorders

Question 4

Other causes of haematuria (5)

Answer 4

BPH/prostate ca.>prostatic bleeds

menstruation

drugs:

• ketamine
• cyclophosphamide>haemorrhagic cystitis

myoglobinuria

radiation cystitis

Question 5

When to routinely refer for haematuria (3)

Answer 5

visible haematuria at any age

symptomatic non-visible haematuria at any age

asymptomatic non-visible haematuria >40yrs on two separate dipsticks

Question 6

when to refer for 2wk wait for bladder ca. (2)

Answer 6

> 45yrs and unexplained visible haematuria w/o UTI or persisting/recurring after Rx of UTI

> 60yrs+unexplained non-visible haematuria+dysuria/raised WCC

Question 7

Hx questions for haematuria (5)

Answer 7

painful?

coagulation disorder?

smoker?

dysuria?

other urinary Sx: frequency, urgency, nocturia, incontinence, LUTS

Question 8

Order of Ix at one stop haematuria clinic (6)

Answer 8

baseline:

• urine dip
• baseline bloods: eGFR, PSA, FBC for anaemia

Examination:

• abdo
• DRE

(then) USS KUB:
- good for looking at upper tract masses and hydronephrosis

(or) CT urogram:
- do after USS if visible haematuria, suspicious USS, RFs or upper tract mass suspected

(then) flexible cystoscopy
- looks at urethra, prostate and bladder
- DO URINE DIP BEFORE
- can cause AUR and infection

(if indicated)Urine cytology:

• e.g. for suspected ca.
• some ca. can cause sterile pyuria

Question 9

Emergency Mx of haematuria (4)

Answer 9

insert 3-way irrigation catheter

USS

rigid cystoscopy under GA

may need transfusion