Hematuria

Published on 31/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

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Chapter 28 Hematuria

INTRODUCTION

Description: Hematuria is the presence of blood, either microscopically or macroscopically, in the urine. Hematuria is a symptom only and requires further evaluation to establish a cause. Hematuria should be considered an indication of malignancy until proven otherwise.
Prevalence: Common in women.
Predominant Age: Any age, most common in reproductive years in association with urinary tract infections.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Disruption of the uroepithelium by infection, neoplasia (benign or malignant), or mechanical trauma (trauma, stone).
Risk Factors: Sexual activity, instrumentation, urinary tract infection, foreign body, or stone.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Painless (or otherwise) passage of blood in the urine

DIAGNOSTIC APPROACH

Differential Diagnosis

• Renal or bladder cancer
• Lower urinary tract infection (urethritis, cystitis)
• Pyelonephritis
• Urolithiasis
• Endometriosis involving the urinary tract
• Traumatic trigonitis
• Interstitial cystitis
• Coagulopathy (iatrogenic or natural)
• Contamination of the urine from another source (vaginal, rectal, anal, factitious)

Associated Conditions: Dysuria, urinary frequency, and urinary tract infections.

Workup and Evaluation

Laboratory: Urinalysis, urine culture and sensitivity (based on other symptoms present).
Imaging: Intravenous or retrograde pyelography. Renal ultrasonography may reveal dilation of the collecting system.
Special Tests: Cystoscopy may be necessary for selected patients. Urine should be collected and passed through a fine screen or mesh if a stone is suspected.
Diagnostic Procedures: History and physical examination, urinalysis.

Pathologic Findings

Based on cause.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Evaluation, hydration.
Specific Measures: Based on the underlying cause; infection should be treated with appropriate antibiotics; stones and tumors require more extensive diagnosis and eventual removal (or passage).
Diet: Adequate fluid intake.
Activity: No restriction except those imposed by the causative process.
Patient Education: Reassurance; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP050 (Urinary Tract Infections).

Drug(s) of Choice

Drug choice is based on cause.

FOLLOW-UP

Patient Monitoring: Normal health maintenance.
Prevention/Avoidance: None.
Possible Complications: Failure to diagnose a malignancy in a timely manner. With large-volume bleeding, clotting with urethral obstruction is theoretically possible.
Expected Outcome: For most patients, complete resolution of their symptoms occurs with appropriate treatment of the base problem.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy except that caused by the underlying condition.
ICD-9-CM Codes: 599.7.

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REFERENCES

Level III

Ahmed Z, Lee J. Asymptomatic urinary abnormalities. Hematuria and proteinuria. Med Clin North Am. 1977;81:641.

Ahn JH, Morey AF, McAninch JW. Workup and management of traumatic hematuria. Emerg Med Clin North Am. 1988;16:145.

Cohen RA, Brown RS. Clinical practice. Microscopic hematuria. N Engl J Med. 2003;348:2330.

Feld LG, Waz WR, Perez LM, Joseph DB. Hematuria. An integrated medical and surgical approach. Pediatr Clin N Am. 1997;44:119.

Foresman WH, Messing EM. Bladder cancer: natural history, tumor markers, and early detection strategies. Semin Surg Oncol. 1977;13:299.

Mahan JD, Turman MA, Mentser MI. Evaluation of hematuria, proteinuria, and hypertension in adolescents. Pediatr Clin North Am. 1997;44:1573.

McCarthy JJ. Outpatient evaluation of hematuria: locating the source of bleeding. Postgrad Med. 1997;101:125.

Pashos CL, Botteman MF, Laskin BL, Redaelli A. Bladder cancer: epidemiology, diagnosis, and management. Cancer Pract. 2002;10:311.

Rodgers MA, Hempel S, Aho T, et al. Diagnostic tests used in the investigation of adult haematuria: a systematic review. BJU Int. 2006;98:1154. Epub 2006 Jul 28

Rosenstein D, McAninch JW. Urologic emergencies. Med Clin North Am. 2004;88:495.

Tomson C, Porter T. Asymptomatic microscopic or dipstick haematuria in adults: which investigations or which patients? A review of the evidence. BJU Int. 2002;90:185.

Wai CY, Miller DS. Urinary bladder cancer. Clin Obstet Gynecol. 2002;45:844.

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