Haematuria

Question 1

Describe haematuria?

Answer 1

• Presence of blood in the urine
  
  • Visible or non-visible

Question 2

What are the classifications of haematuria?

Answer 2

• Visible (VH)
  
  • pink, red or dark brown urine
• Non-visible (NVH) - dipstick positive
  
  • Symptomatic (n-NVH) - eg suprapubic pain, renal colic
  • Asymptomatic (a-NVH)

Question 3

What are the classifications of haematuria aetiology?

Answer 3

Question 4

Describe pseudohaematuria?

Answer 4

• Red/brown urine which is not secondary to haemoglobin presence
• Causes:
  
  • Rifampicin, methyldopa
  • Hyperbilirubinuria, myoglubinuria
  • Beetroot, rhubarb

Question 5

Urological causes of haematuria?

Answer 5

• Infection of urinary tract
• Malignancy
• Renal calculi
• Trauma or recent surgery
• Radiation cystitis

Question 6

What investigations should be performed for suspected haematuria?

Answer 6

• Urinalysis
• FBC, U&Es, clotting, PSA
• Urinary protein levels
  
  • albumin:creatinine ratio
  • protein: creatinine ratio

Question 7

What do NICE recommend are the criteria which warrant urgen urological referral?

Answer 7

• Aged >45yrs with either:
  
  • Unexplained visible haematuria without UTI
  • Visible haematuria which persists after treatment
• Aged 60+ yrs with unexplained non-visible haematuria + dysuria or WCC

Question 8

What specialist investigations can be performed by urology?

Answer 8

• Flexible cystoscopy
• Urine cytology if confirmed malignancy
• US KUB
• CT urogram

Question 9

• Which of the following medications is NOT a possible cause of haematuria?
  
  • Cyclophosphamide
  • Naproxen
  • Rivaroxaban
  • Nitrofurantoin

Answer 9

Rivaroxaban

Question 10

• Which of the following is most likely to be the cause of terminal haematuria?
  
  • Bladder stone
  • Prostate cancer
  • Renal cell carcinoma
  • Renal arteriovenous malformation

Answer 10

Bladder stone

Question 11

Describe the source of total/complete haematuria?

Answer 11

At or above the level of the bladder

Question 12

Describe the source of initial haematuria?

Answer 12

• Prostate
• Anterior urethra

Question 13

Describe the source of midstream haematuria?

Answer 13

At or above the level of the bladder

Question 14

Describe the source of terminal haematuria?

Answer 14

• Posterior urethra
• Bladder neck
• Trigone of bladder