Prostate acinar adenocarcimona Risk factors for haematuria Risk factors can help in determining which patients are at higher risk of urinary tract and bladder cancer. Investigations There are a number of recommended investigations Macro hematuria prosztatitis the assessment of haematuria, including urine sampling, blood tests and imaging Figure 1.
Hematuria (Blood in the Urine)
An approach to the investigation and initial management of macroscopic haematuria3,7,13,17 Urine dipstick A urine dipstick can give instant results and tests for haemoglobin. It relies on Hb to catalyse the oxidation of a chromagen by organic hydrogen peroxide. Unfortunately, myoglobin, bacterial peroxidases, povidone and hypochlorite can also cause this reaction, which can result in false positives.
Urinary tract infections are one of the most common causes of haematuria, and this should be ruled out before an episode of haematuria is investigated further. Red cell morphology can also be useful in determining whether the source is glomerular or urinary tract,7 and can therefore minimise unnecessary urinary tract imaging.
A urine albumin:creatinine ratio assesses albumin excretion and may be useful in cases where it is uncertain if the cause for renal impairment is renal or post-renal.
It has the greatest sensitivity with bladder carcinoma specifically high grade and carcinoma in situ but is less sensitive for upper tract transitional cell carcinomas.
Hematuria I. Hematuria means blood in the urine.
Cytology is useful as an adjunct to cystoscopy and can be used for the ongoing evaluation of asymptomatic microscopic haematuria post-cystoscopy and for follow up of high grade urothelial cancer and carcinoma in situ. Sensitivity of urine cytology can be increased by testing mid morning or random specimens from three separate voids.
PSA levels can also be raised in urinary tract infections, urinary retention and benign prostatic hypertrophy. Imaging X-ray kidneys, ureters, bladder X-ray of the kidneys, ureters, bladder XR-KUB is useful in identifying and monitoring radio opaque ureteric and renal stones, but is not useful in assessing the urinary tract.
Sensitivity for detecting urinary tract lesions is 50— It also allows for general but limited assessment of the prostate gland and the effects of bladder emptying.
Ultrasound usually requires follow up with a corresponding CT scan. Ultrasound has a lower diagnostic yield and is less sensitive for ureteric and bladder tumours compared to CT. Therefore it is the second investigative modality Macro hematuria prosztatitis choice if CT is unavailable.
Sensitivity for detecting pathology in patients with haematuria Lehet- e betegnek beteg a prosztatitis from Flexible cystoscopy can be performed under local anaesthetic. Tissue can be biopsied for further analysis during the procedure, although inadequate tissue sampling is a common problem. Rigid cystoscopy is performed under a general anaesthetic and Macro hematuria prosztatitis typically indicated for lesions seen on imaging or flexible cystoscopy, and in cases where a biopsy or tumour resection is anticipated.
Medical Student Curriculum: Hematuria
It can also identify strictures or a source of bleeding from the bladder wall, prostate and ureters. It is recommended in patients with haematuria for those aged more than 40 years, or who have risk factors for urinary tract or bladder cancer.
A smaller percentage with more significant haematuria including a high risk of clot retention, haemodynamic instability, a drop in haemoglobin, or cardiovascular symptoms will require hospital admission for continuous bladder irrigation and management of symptomatic anaemia.
Urethral discharge or tear Lower extremity edema A thorough history and focused physical examination can lead to a proper evaluation and subsequent management.
The most common acute emergency presentation of haematuria Macro hematuria prosztatitis acute urinary retention secondary to blood clots clot retention. This typically presents with acute abdominal pain and an inability to urinate.
In these cases, patients will also need catheter insertion and continuous irrigation. Blood transfusions may also be required.
In severe cases, patients may require emergency cystoscopy and diathermy if they are Macro hematuria prosztatitis responding to conservative management. Urinary tract infection Any urinary tract Macro hematuria prosztatitis should be treated empirically, with treatment modified if needed based on sensitivities.
Ureteric and renal stones Ureteric and renal stones can initially be conservatively managed. Non-steroidal anti-inflammatories are the most useful treatment for renal colic, however, stronger opiate analgesia is often required.
- Prosztata méretének csökkentése
- Isolated Hematuria - Genitourinary Disorders - MSD Manual Professional Edition
The use of alpha-blockers, such as prazosin and tamsulosin, are also useful in the passage of distal ureteric stones.