Urology: Haematuria

Question 1

Name the 4 most common causes of haematuria.

Answer 1

1. UTI
2. Urinary tract stones
3. Urethritis
4. BPH

Question 2

Suggest different infections that can cause haematuria.

Answer 2

Cystitis
Urethritis
Prostatitis
Tuberculosis 
Schistosomiasis 
Infective endocarditis

Question 3

Suggest different types of tumour that can cause haematuria.

Answer 3

Renal carcinoma
Wilm’s tumour
Bladder carcinoma
Prostate cancer
Urethral cancer
Endometrial cancer

Question 4

Suggest inflammatory causes for haematuria.

Answer 4

Glomerulonephritis
IgA nephropathy
Goodpasture’s syndrome

Question 5

Suggest ‘structural’ causes for haematuria.

Answer 5

Calculi (renal, bladder, ureteric)
Simple cysts
Polycystic renal disease
Congenital vascular anomalies

Question 6

Suggest haematological causes of haematuria.

Answer 6

Sickle cell disease
Coagulation disorders
Anti-coagulation therapy

Question 7

Name 3 drugs that can cause haematuria.

Answer 7

Sulphonamides
Cylcophosphamide
NSAIDs

Question 8

Which Qs should be asked in a history of haematuria?

Answer 8

Timings

1. Onset, duration, frequency
2. Occurence during urine stream
3. Does bleeding occur when not passing urine?
4. Any obvious preceding events, e.g. catheter, recent throat infections (glomerulonephritis), travel (Lake Malawi - schistosomiasis)

Characteristics

1. Is blood frank or microscopic?
2. Colour: pink (e.g. UTI, urethritis), bright red (e.g. trauma), deep brown (e.g. hyperbilirubinaemia)
3. Any clots? (Worm-shaped = upper urinary tract disorder)
4. Quantity

Associated symptoms

1. Pain on urinating? Where, if radiates, if only associated with urinating. (Urethra tip = UTI, urethritis, loin = renal stones, pyelonephritis)
2. Increased urinary frequency, nocturia? (e.g. UTI)
3. Poor flow, hesitancy, terminal dribbling? (E.g. prostate cancer, BPH)
4. Fever (infection, e.g. UTI, pyelonephritis, prostatitis)
5. Night sweats (e.g. renal or bladder malignancy, TB)
6. Weight loss (malignancy)
7. Dizziness, fatigue, SOB - may indicate anaemia due to haematuria

Question 9

Which causes are associated with haematuria occurring at start, throughout/midstream or end of urine stream?

Answer 9

Start: lower urinary tract pathology, e.g. UTI, urethritis

Midstream: bladder/ureter pathology, e.g. stones, bladder cancer, trauma

End: bladder neck pathology, schistosomiasis

Question 10

Which investigations could be performed for haematuria?

Answer 10

1. Urine dipstick: leukocytes, nitrites, protein, protein:creatinine ratio
2. Bloods: FBC (anaemia), clotting screen
3. Urine microscopy and culture: treat infection if +ve
4. Urine cytology
5. Cystoscopy
6. USS KUB
7. CT KUB