Sandbox:Hematuria management: Difference between revisions
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* Useful for detecting urinary casts (suggesting renal disease) | * Useful for detecting urinary casts (suggesting renal disease) | ||
* Useful for detecting urinary crystals (suggesting calculous disease) | * Useful for detecting urinary crystals (suggesting calculous disease) | ||
* Useful for detecting dysmorphology of red cells (suggesting a glomerular cause of | * Useful for detecting dysmorphology of red cells (suggesting a glomerular cause of hematuria) | ||
* Useful for detecting atypical or malignant epithelial cells from a tumour are shed into the urine. | * Useful for detecting atypical or malignant epithelial cells from a tumour are shed into the urine. | ||
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=== Investigation of the lower urinary tract === | === Investigation of the lower urinary tract === | ||
'''Cytoscopy:''' Flexible cystoscope is useful for the inspection of the urethra and visualization of the bladder mucosa. The detection of an abnormality will require subsequent rigid cystoscopy under anaesthesia, whereby tissue can be obtained or treatment performed. | '''Cytoscopy:''' Flexible cystoscope is useful for the inspection of the urethra and visualization of the bladder mucosa. The detection of an abnormality will require subsequent rigid cystoscopy under anaesthesia, whereby tissue can be obtained or treatment performed. | ||
=== Investigation of the upper urinary tract === | |||
This is controversial for the Investigation of the upper urinary tract cause of hematuria. No single imaging modality has the desired attributes of a high sensitivity and specificity, safety (low radiation exposure), low cost and applicability to lots of patients. | |||
The initial evaluation of patients presenting with gross hematuria is 3-fold:<ref name="pmid27261791">{{cite journal| author=Avellino GJ, Bose S, Wang DS| title=Diagnosis and Management of Hematuria. | journal=Surg Clin North Am | year= 2016 | volume= 96 | issue= 3 | pages= 503-15 | pmid=27261791 | doi=10.1016/j.suc.2016.02.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27261791 }}</ref> | The initial evaluation of patients presenting with gross hematuria is 3-fold:<ref name="pmid27261791">{{cite journal| author=Avellino GJ, Bose S, Wang DS| title=Diagnosis and Management of Hematuria. | journal=Surg Clin North Am | year= 2016 | volume= 96 | issue= 3 | pages= 503-15 | pmid=27261791 | doi=10.1016/j.suc.2016.02.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27261791 }}</ref> | ||
Revision as of 17:57, 29 November 2016
Diagnosis
Urine-based tests
A fresh sample of urine should be dipstick tested for proteinuria (renal disease) or nitrituria (infection). If abnormal the sample should be sent for microbiological assessment (microscopy and culture) and cytology.
| Microscopy | Urine cytology |
|---|---|
|
Microscopy is performed on urinary sediment (following centrifuging a fresh urine sample) and can quantify the number of erythrocytes. Advantages
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Urine cytology is the ‘gold standard’ urine-based test for detecting cancer. Advantages
|
Investigation of the lower urinary tract
Cytoscopy: Flexible cystoscope is useful for the inspection of the urethra and visualization of the bladder mucosa. The detection of an abnormality will require subsequent rigid cystoscopy under anaesthesia, whereby tissue can be obtained or treatment performed.
Investigation of the upper urinary tract
This is controversial for the Investigation of the upper urinary tract cause of hematuria. No single imaging modality has the desired attributes of a high sensitivity and specificity, safety (low radiation exposure), low cost and applicability to lots of patients.
The initial evaluation of patients presenting with gross hematuria is 3-fold:[1]
- Assess hemodynamic stability
- Determine the underlying cause of hematuria
- Ensure urinary drainage.
Evaluation of patients with haematuria includes a focussed history and physical examination, urinalysis and various blood tests.Most importantly the lower urinary tract should be visualized using cystoscopy, usually using a flexible scope, and the upper tract imaged by a combination of modalities including plain X-ray, ultrasonography, intravenous urography or computed tomography urography.
The treatment options for haematuria depend on the underlying cause.
References
- ↑ Avellino GJ, Bose S, Wang DS (2016). "Diagnosis and Management of Hematuria". Surg Clin North Am. 96 (3): 503–15. doi:10.1016/j.suc.2016.02.007. PMID 27261791.