Urology: haematuria

Question 1

How do you distinguish between visible haematuria, non-visible haematuria and pseudohaematuria?

Answer 1

Visible = urine is coloured pink, red, brown
Non-visible = id with urine dip stick. May be asyptomatic/symptomatic. Pseudohaematuria = red/brown urine which is not secondary to Hb in the urine. It can be due to other causes - meds, hyperbilirubinuria, myoglobinuria, beetroot, rhubarb

Question 2

What are 2 urological causes of haematuria?

Answer 2

UTI, urothelial carcinoma, renal calculi, trauma, radiation cystitis, prostate cancer, BPH

Question 3

How may patient present, if they have haematuria?

Answer 3

Secondary symptoms - LUTs, fever, flank pain. Trauma, surgical Hx, co-morbidities, taking anticoagulants, smoker.

Question 4

What investigations might you want to do in pt presenting w haematuria?

Answer 4

Urinanalysis - nitrates, leukocytes. MSSU, FBC, U+Es, coat screen, PSA, albumin:creatinine

Question 5

What imaging might you order for pt with haematuria?

Answer 5

USS, CT KUB. Cytoscopy

Question 6

In which patients would you want to Admit and catheterise with 3 way, order urgent US/CT KUB and consider abx?

Answer 6

If pt is 1) in retention 2) bloods are abnormal 3) heavy haematuria 4) history or renal trauma

Question 7

A 50 yr old pt presents in ED with hameaturia but on questioning, you find out that they have no voiding problems. Bloods are normal. Urine is light red. What is your management?

Answer 7

Urgent 2 week wait referral
As >45 years and unexplained visible haematuria without urinary tract infection or visible haematuria that persists after successfully treating UTI

Question 8

Causes of painless haematuria?

Answer 8

Malignancies - bladder cancer
Pseudohaematuria: Beetrot, rifampicin, myoglobin (if you have rhabdomyalsis), porphyrin

Question 9

Pt has come into A+E with haematuria. Ar differencials for this

Answer 9

can be split up into microscopic, frank. Or - painless, painful.

Causes of transient or spurious non-visible haematuria
* urinary tract infection
* menstruation
* vigorous exercise (this normally settles after around 3 days)
* sexual intercourse

Causes of persistent non-visible haematuria
* cancer (bladder, renal, prostate)
* stones
* benign prostatic hyperplasia
* prostatitis
* urethritis e.g. Chlamydia
* renal causes: IgA nephropathy, thin basement membrane disease

Spurious causes - red/orange urine, where blood is not present on dipstick
* foods: beetroot, rhubarb
* drugs: rifampicin, doxorubicin

See table for causes from PM: