Flashcards in MANAGEMENT OF HAEMATURIA Deck (19)
How do we split up the causes of haematuria?
Post-renal - Ureteric / Bladder / Prostatic / Urethral
What are the innocent causes of apparent haematuria?
Acute intermittent porphyria
Beetroot, blackberries, rhubarb
Drugs: nitrofurantoin, senna, rifampicin, chloroquine and doxorubicin
What are the pre-renal causes of haematuria?
Atrial fibrillation - warfarin therapy and embolism
What are the renal causes of haematuria?
Polycystic kidney disease
Haemolytic uremic syndrome
What are ureteric causes of haematuria?
What are the bladder related causes of haematuria?
What are the prostatic causes of haematuria?
What are the urethral causes of haematuria?
Urethral meatal ulcer
Who should be urgently referred on a two week wait basis for further investigations regarding haematuria?
All those with visible haematuria not associated with UTI or where symptoms recur or persist despite UTI treatment
Those aged 60 or over who have unexplained non-visible haematuria and either dysuria or a raised WCC
Who should be non-urgently referred for further investigations regarding haematuria?
Aged 60 or over with recurrent or persistent unexplained UTI
Aged 40 or over with asymptomatic non-visible haematuria.
Patients under the age of 40 years with normal renal function, no proteinuria and who are normotensive do not need to be referred, unless they have symptoms not explained by UTI.
What are the investigations that might be done in someone with haematuria?
Urine albumin:creatinine ratio
ESR/PV (plasma viscocity)
Cystoscopy under local anaesthetic
What are the disadvantages of measuring PSA?
High reading has a low specificity eg BPH, UTI, ejaculation
May prompt unnecessary prostate biopsy, a procedure with significant morbidity
A low reading does not exclude prostate cancer
When might you do a CT urogram in a patient who presents with haematuria?
If USS shows a mass lesion in the kidneys
How is flexible cystoscopy performed?
Day patient case
Urine dip to exclude UTI
Antiseptic applied to glans penis or female urethral meatus
Injection of lignocaine gel into urethra
Introduce flexible cystoscope
Inspect urethra, prostate, bladder neck and bladder
What is flexible cystoscopy good at diagnosing?
Bladder lesions such as transitional cell carcinoma
What percentage of urinary tract stones are radio-opaque (and therefore picked up on x-ray)?
What is a complication of haematuria which can present as an emergency?
What is bladder clot retention?
A complication of bleeding into the bladder. A clot forms which then blocks the bladder outflow causing severe acute retention.