Hematuria Wanda C. Hancock, MHSA, PA-C. Objectives Discover the presenting symptoms for hematuria...
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Transcript of Hematuria Wanda C. Hancock, MHSA, PA-C. Objectives Discover the presenting symptoms for hematuria...
It’s a Bloody Mess!Hematuria
Wanda C. Hancock, MHSA, PA-C
ObjectivesDiscover the presenting symptoms for
hematuria and the anticipated decision path for its etiology
Develop an initial differential diagnosis for hematuria
Consider the diagnostic orders for developing the diagnosis
Determine the likely follow up testing.
Hematuria is a sign of malignancy until proven otherwise
Incidence43% of microscopic hematuria has no
etiology5% of microscopic hematuria is cancer23% of gross has cancer as an initial finding8% has no etiology initially but 18% findings
later
CausesCancerBPH TraumaSurgery/
instrumentationMedicationsRenal DiseaseExercise
StonesRadiationChemotherapyFeverBenzenesUTIRecent URTI
Risk FactorsAgeSmokingTraumaPrevious exposure to chemicals
How to Shine….Gross or microscopic?Timing?Pain?Clots?
Gross VS MicroGross hematuria
Always needs evaluationSources
MicroscopicDip stick has 90% sensitivity3-5 RBC HPF2 of 3 tests positive
Timing ….Initiation of the streamTerminal hematuria Throughout the micturation
Painful versus painlessPainful
CystitisStones
PainlessNeoplasm
Clots?AmorphousVeriform
PeePee on T(4)hisPeriod, pseudo hematuriaProstateObstructionNephritisTraumaTumorTBThrombosisHematologicInfection/InflammationStone
EvaluationPMHFMHPELaboratoryImaging
Past Medical HistoryRadiationSurgeryTBAutoimmune diseaseExerciseTraumaRecent URTILUTS
Family HistoryHTNPCKDAlport SyndromeStonesCancer
Physical ExaminationBlood pressurePallorRashesEdemaMurmurPalpable massFlank painDREPelvic
Laboratory testsUrine DipMicroscopic
examinationCultureCytologyCreatinine, BUNPT/INR
UrovisionOther
ANASCDTB
ImagingIVP or CT urogramUltrasoundMRI or CTRetrograde pyelogramMag 3 / renal scanCystogram
Differential DiagnosisPseudohematuria
Drugs, vegatables, dyesMyoglobinMenstrationDysfunctional bleeding
CongenitalCystic renal diseaseAlports diseaseRenal tubual disorder
Differential DiagnosisAnatomic
StricturesPhimosisPosterior urethral valvesDiverticulumUPJ obstructionVesicouretric reflux
Vascular malformationTraumaExercise inducedForeign body/inflammatory
Follow UpNegative CT, cytology, cystoscopyClinic follow up should be scheduled
6, 12, 24, 36 monthsUA, BP, cytology
RetestingChange of symptomsGross hematuria develops
ResourcesCampbell-Walsh Urology, 9th edition. Wein, Alan, et al.
Saunders/Elsevier, Philadelphia, PA, 2007.Clinical Manual of Urology, 3rd edition. Hanno, Phillip,
Malkowicz, S. Bruce, Wein, Alan. McGraw-Hill, NY, NY, 2007.Office Urology: The Clinican’s Guide. Kursh, Elroy D.,
Ulchaker, James C.. Humana Press, Totowa, NJ, 2001.Pocket Guide to Urology, 3rd edition. Wieder, Jeff A.. Griffith
Publishing, Caldwell, ID, 2007.Smith’s General Urology, 17th edition.Tanngho, Emil A.,
McAninch, Jack W.. McGraw-Hill/Lange, NY, NY, 2008.The 5-Minute Urologic Consult, 2nd edition. Gomella, Leonard
G. Lippincott Williams & Wilkins, Philadelphia, PA, 2010.Urology House Officer Series, 4th edition. Macfarlane, Michael
T. Lippincott Williams & Wilkins, Philadelphia, PA, 2006.