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Urology - Surgery > Haematuria > Flashcards

Haematuria Flashcards

1
Q

What is haematuria?

A

The presence of blood in the urine. IT IS NEVER NORMAL.

Can be:

  • Visible – seen by the naked eye
  • Non-visible – confirmed by urine dipstick
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2
Q

Define visible haematuria

A

Blood visible in the urine, colouring it pink, red or dark brown.

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3
Q

Define non-visible haematuria

A

Blood is present in urine on urinalysis but not visible.

Divided into a further 2 categories:

  • Symptomatic non-visible haematuria (s-NVH)
  • Asymptomatic non-visible haematuria (a-NVH)
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4
Q

What is symptomatic non-visible haematuria (s-NVH) ?

A

Haematuria present with associated symptoms such as sub-pubic pain or renal colic

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5
Q

What is asymptomatic non-visible haematuria (a-NVH) ?

A

Haematuria with no associated symptoms

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6
Q

What is pseudohaematuria?

A

Red or brown urine that is not secondary to presence of haemoglobin.

Can be caused by:

  • Medication (e.g. Rifampicin / Methyldopa)
  • Hyperbilirubinuria
  • Myoglobinuria
  • Certain foods (e.g. beetroot and rhubarb)
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7
Q

What are the risk factors for haematuria?

A
  • Smoking
  • Recent infection
  • Family history
  • Cancers
  • Unprotected sex (in men)
  • Relevant travel Hx
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8
Q

What are the 5 most common causes of haematuria?

A
  • Urinary tract infection (UTI)
  • Urothelial carcinoma
  • Stone disease
  • Adenocarcinoma of the prostate
  • Benign prostatic hypertrophy (BPH)
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9
Q

What are the broader causes of haematuria?

A
  • Infection
  • Malignancy
  • Stones
  • Renal disease
  • Trauma
  • Structural abnormalities
  • Other

Also consider that many of these causes can occur at any point throughout the urological tract.

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10
Q

Give some specific examples of infectious causes of haematuria

A
  • UTI
  • Pyelonephritis
  • Cystitis
  • Prostatitis
  • STIs (e.g. chlamydia)
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11
Q

Give some specific examples of malignant causes of haematuria?

A
  • Urothelial cancer
  • Adenocarcinoma of the prostate
  • RCC
  • Penile cancers
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12
Q

Give some specific examples of trauma that can lead to haematuria?

A
  • Bladder trauma (e.g. pelvic fracture)
  • Injury to renal tract
  • Blunt renal injury
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13
Q

Give some specific examples of renal conditions that can cause haematuria?

A
  • Glomerulonephritis
  • IgA nephropathy
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14
Q

What are some specific structural causes of haematuria?

A
  • BPH
  • Polycystic kidney disease
  • Renal vein thrombosis
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15
Q

Give other causes of haematuria / discoloured urine

A
  • Menstruation
  • Exercise
  • Drugs
    • Rifampicin
    • Nitrofurantoin
    • Cyclophosphamide
    • Naproxen
  • Schistosomiasis
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16
Q

What are the risk factors for schistosomiasis?

A
  • Travel / migration from Africa, South America, the Caribbean, the Middle East and Asia.
  • Swimming in fresh water in these regions
17
Q

What are the causes of transient non-visible haematuria?

A
  • UTI
  • Menstruation
  • Sexual intercourse
  • Vigorous exercise
18
Q

What are the causes of persistent non-visible haematuria?

A
  • Cancer
  • Stones
  • BPH
19
Q

What would you want to ask about haematuria as a presenting complaint?

A
  • Assess the degree of haematuria
    • Colour of urine?
    • Clots?
  • Timing in the stream
    • Constant? Sporadic?
    • Total haematuria suggests bladder / upper tract source
    • Terminal haematuria potentially severebladder irritation
  • Associated symptoms
    • Lower Urinary Tract Symptoms (LUTS)?
    • Fevers or rigors?
    • Suprapubic / flank pain?
    • Weight loss?
    • Recent trauma?
20
Q

Once you have gained a full understanding of the history of presenting complaint, what are important points to note in the rest of the history?

A
  • Drug history
  • Smoking status
    • Increased risk of urological malignancies
  • Exposure to industrial carcinogens
    • Increased risk of bladder cancer
  • Recent foreign travel
    • Increased risk of schistosomiasis
21
Q

How are you going to examine a patient presenting with haematuria?

A
  • Abdo exam (inc balotting kidneys & palpating bladder!)
  • DRE +/- Examination of external genitals
22
Q

What initial investigations would you order to investigate haematuria?

A
  • Urinalysis (Dipstick)
    • Nitrites / leukocytes may indicate infection
  • FBC
    • Assess infection / anaemia
  • U&Es
    • Assess kidney function
  • Clotting
    • Assess bleeding status
  • PSA (after appropriate counselling)
    • When prostatic pathology is a possible cause of haematuria.
  • Urinary protein levels (albumin:creatinine ratio or protein:creatinine ratio)
    • In those with deranged function / suspected nephrological cause
23
Q

What value on a dipstick is classified as haematuria?

A

≥1+ blood constitutes haematuria

IT’S NOT HAEMATURIA WITH ‘TRACE’ BLOOD

24
Q

What specialist investigations would you order?

A
  • Flexible cystoscopy = Gold standard for assessing the lower urinary tract (EVERY CASE SHOULD HAVE ONE)
    • Under local anaesthetic
  • Urine cytology (sometimes)
    • More commonly used in follow-up of patients with proven malignancy, but can be used in the initial assessment
  • US KUB
    • Cheap and non-invasive method
    • Typically used for non-visible haematuria
  • CT Urogram
    • More definitive imaging but higher radiation exposure
    • Typically used for visible haematuria
25
Q

What is the criteria for urgent referral to a urological service?

A
  • Aged ≥45yrs with either:
    • Unexplained visible haematuria without UTI
    • Persistant / recurring visible haematuria after successful treatment of UTI
  • Aged 60yrs
    • Unexplained non‑visible haematuria with dysuria / raised WCC on FBC
  • Patients w/ asymptomatic non-visible haematuria on two out of three tests
26
Q

What is the management of haematuria?

A

Treatment of the underlying pathology.

27
Q

What percentage of haematuria is found to be due to malignancy?

A

Approx. 20% with visible haematuria and 5% of patients with non-visible haematuria are found to have an underlying malignancy.

Urology - Surgery (12 decks)

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