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Urology – Hematuria
Whiteboard Animation Transcript
with Sandip Prasad, MD
[ Ссылка ]
Seeing blood in your urine is dramatic and worrisome, however, it takes very little blood to produce a colour change. Blood can enter the urinary system at any point from the kidneys down to the end of the urethra.
Many benign reasons exist for hematuria, and sometimes the reason will never be identified. The following are the causes you cannot afford to miss:
1. Kidney, bladder, and advanced prostate cancer can initially present with blood in the urine, and timely evaluation and early diagnosis improve the chances of survival. Patients with gross hematuria with a smoking history, exposure to chemicals and dyes, flank pain, or irritative voiding symptoms should be closely evaluated to rule out malignancy.
2. Kidney or bladder stones can cause severe patient discomfort and can lead to long-term renal damage. Any patient with hematuria, prior stone history, or flank pain should be evaluated for nephrolithiasis.
3. While urinary tract infections are common and often easily treatable, if they go unchecked, more serious and life-threatening complications can result including pyelonephritis or urosepsis. Think of this in patients with urinary frequency, a strong smell to the urine, fevers, chills, suprapubic pain, flank pain, or dysuria.
4. Trauma victims can present with hematuria, which can indicate serious injury to the kidneys, bladder, or urethra. These patients can require urgent urologic intervention
5. Patients on anticoagulation or with history of hemophilia or thrombocytopenic purpura should be evaluated for bleeding diathesis when presenting with hematuria. If left uncorrected, life-threatening complications can arise.
6. An enlarged prostate can lead to microscopic or visible blood in the urine. You may see difficulty starting your stream or urinary frequency/urgency. Medical kidney diseases such as glomerulonephritis often cause microscopic urinary bleeding.
The workup for hematuria is typically performed on an outpatient basis with cystoscopy, CT Urogram, and urine cytology and culture.
