Haematuria

Question 1

Definition

Answer 1

Presence of blood in the urine

It should never be ignored

Question 2

2 types of haematuria

Answer 2

Visible - macroscopic

Non-visible - microscopic

Question 3

Visible haematuria

Answer 3

Macroscopic

Gross, frank haematuria

Question 4

Visible haematuria is regarded as a symptom of urologic malignancy until proven otherwise. True or false?

Answer 4

True

Question 5

Non visible haematuria

Answer 5

Microscopic
Found on urinalysis
Check for risk factors of cancer development

Question 6

Symptomatic non-visible haematuria

Answer 6

UUTS:
- colic
LUTS: 
- frequency
- hesitancy 
- urgency
- dysuria
- retention
- incontinence

Question 7

Asymptomatic non-visible haematuria

Answer 7

Incidental finding

Question 8

Causes - benign

Answer 8

Infection
Stones
BPH

Question 9

Causes - malignant

Answer 9

Tumours

• RCC (all ages)
• TCC (e.g. of bladder - over 50)
• invasion from other sites

Question 10

Causes - trauma

Answer 10

Haematoma

Sport haematuria

Question 11

Causes - medication

Answer 11

Anticoagulants
Rifampicin
Nitrofurantoin
Chloroquine

Question 12

Causes - contamination

Answer 12

Menstrual
Foods - beetroot
Myoglobin

Question 13

Long and worm like clots are said to be from the UPPER/LOWER urinary tract?

Answer 13

Upper

Question 14

Shapeless clots are said to be from the UPPER/LOWER urinary tract?

Answer 14

Lower

Question 15

Schistosome gives you an increased risk of developing which type of cancer?

Answer 15

Squamous cell carcinoma

Question 16

Clinical examination

Answer 16

Abdominal exam
Bladder exam
PR exam

Question 17

Always refer patients (of any age) with visible haematuria for further testing. True or false?

Answer 17

True

Question 18

Do not always need to refer patients (of any age) with symptomatic non-visible haematuria for further testing. True or false?

Answer 18

False

- always refer these patient

Question 19

All patients with asymptomatic non visible haematuria should be sent for further testing. True or false?

Answer 19

False

- only if 40 and over

Question 20

Investigation aims

Answer 20

Examine the whole urinary tract by the simplest means

Question 21

Investigation options are the same irrespective of age?

Answer 21

False

- depend on age

Question 22

First line investigations

Answer 22

Urinalysis

Urine sample sent for C+S

Question 23

What is cytology good for?

Answer 23

High grade cancer detection

Question 24

First line imaging test

Answer 24

US

Question 25

Which investigation is commonly carried out after US?

Answer 25

CT

MRI

Question 26

Contrast imaging

Answer 26

IV urogram

CT urogram

Question 27

IV urogram - function

Answer 27

Shows filling defects

Question 28

IV urogram - if bladder is filled with contrast but the contrast does not reach the bladder walls, what is the suspected pathology?

Answer 28

Bladder cancer

- filling some but not all of the bladder

Question 29

What is the first line investigation if there is frank haematuria in over 50 year olds?

Answer 29

CT urogram

Question 30

CT urogram - function

Answer 30

Examines kidneys, collecting systems and ureters

Question 31

CT urogram - procedure

Answer 31

CT with no contrast: most sensitive way to detect calculi
Administer 75ml contrast - look at collecting system and ureters
Administer another 75ml contrast after 15 mins - enhances renal parenchyma

Question 32

Use CT urogram in people under 50 and over 50?

Answer 32

False

• over 50 only.
• under 50yo less likely to have cancer

Question 33

Cytoscopy - what is it good to use in?

Answer 33

Bladder investigation