What is Hematuria?

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Hematuria (American English) or haematuria (British English) is a clinical sign. It is defined by the presence of blood or red blood cells in the urine. An anatomical framework is helpful in developing a comprehensive differential diagnosis. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. These include the urinary system, female reproductive system, and integumentary system. After conducting a thorough history and physical examination, further medical testing is warranted. Patients can be stratified into high and low risk. High risk patients include those with visible hematuria or those with non-visible hematuria and risk factors. A complete evaluation of the urinary tract is indicated for hematuria. This includes imaging of the upper urinary tract and cystoscopy of the lower urinary tract.

Urinary causes occur anywhere between the kidney glomerulus and the urethral meatus. These can be divided into glomerular and non-glomerular causes. Non-glomerular causes can be further subdivided into upper urinary tract and lower urinary tract causes. In general, nephrologists are the experts of glomerular hematuria while urologists manage non-glomerular hematuria. The differential diagnosis can be furthered refined by the temporality of hematuria and associated symptoms. Microscopic hematuria has a prevalence of 2-31%.

The differential diagnosis can be furthered refined by the temporality of hematuria and associated symptoms. During urination, blood can appear in the urine at the onset, midstream, or later.  It can also have associated symptoms. These include nausea, fever, chills, abdominal pain, flank pain, groin pain, urinary frequency, urinary urgency, and pain or discomfort with urination. When hematuria becomes visible during urination can suggest where in the urinary tract the bleeding originates. If it appears soon after the onset of urination, a distal site is suggested. The presence of hematuria without accompanying symptoms should be considered a tumor of the urinary tract until proven otherwise.

After conducting a thorough history and physical examination, further medical testing is warranted. Patients can be stratified into high and low risk. High risk patients include those with visible hematuria or those with non-visible hematuria and risk factors. A complete evaluation of the urinary tract is indicated for hematuria. This includes imaging of the upper urinary tract and cystoscopy of the lower urinary tract.

Blood clots that remain in the bladder are digested by urinary urokinase producing fibrin fragments. These fibrin fragments are natural anticoagulants and promote ongoing bleeding from the urinary tract. Removing all blood clots prevents the formation of this natural anticoagulant. This in turns facilitates the cessation of bleeding from the urinary tract. The acute management of obstructing clots is the placement of a large (22-24 French) urethral Foley catheter. Clots are evacuated with a Toomey syringe and saline irrigation. If this does not control the bleeding, management should escalate to continuous bladder irrigation (CBI) via a three-port urethral catheter. If both a large urethral Foley catheter and CBI fail, an urgent cystoscopy in the operating room will be necessary. Lastly, a transfusion and/or a correction of a coexisting coagulopathy may be necessary.

Media contact;

Amalia Azzariti,

Editorial Manager,

Journal of Clinical Oncology and Cancer Research,

WhatsApp: +441470490003        

Email: clinoncol@eclinicalsci.com