Hematuria

Differential Diagnosis:

Stones:

History

• Continuous loin to groin pain
• Suggesting ureteric stone
• Dull and aching pain
• Suggesting stone in minor/major calyces
• Hematuria
• Vomiting
• Sweating
• UTI symptoms
• Risk factors
Poor fluid intake
• 
  
• Hyperparathyroidism
• Examination – Patient in agony

Elderly men
• 
  
Symptoms of
• 
  
• Obstruction
• Poor, intermittent stream
• Hesitancy
• Dribbling
• Retention
• Irritative
Frequency
• 
  
• Urgency
• Nocturia
• Renal failure
• Drowsiness
• Headaches
• Disorientation
  

• 
  
• Uremia
• Pale and wasted
• Dry furry tongue
• Mentally confused
• Large bladder
• DRE
• BPH
• Lateral lobes enlarged
• Sulcus palpable
• CA
• Posterior part hard and craggy obliterating sulcus

• Painless gross hematuria
• Older patient
• With/without irritative symptoms (ulcerating CA)
• Risk factors
• Smokers
• Industrial chemicals
• Dye and rubber industry
• Radiation therapy

• Malignant tumor
• Felt on bi-manual exam
• Pale
• Cachexic
• Anemic
• Benign
• May be negative

• Young child with history of
• Sore throat
• Ankle face swelling
• Recurrent infections
• Examination
• Edema
• Peri-orbital swelling
  

• Flank pain *
• Hematuria
• Weight loss
• 40-60 yr
• Male > female

• Palpable mass *
• HTN *
• Cachexia
• * Classical Triad

• Females predominate
• Sequelae of
• Sex
• Urethral catheterization
• Symptoms of urgency
• Frequency and dysuria
• Fever and loin pain (ascending infection)

• Pyrexia
• Suprapubic tenderness
• Loin tenderness

• CBC
• Hb
• Reduced in CA
• Reduce in BPH due to uremia
• WBC
• Increased in UTI
• Platelets
• Thrombotic Thrombocytopenic Purpura (TTP)
• U&E
• Increased urea due to BPH
• Kidney function
• PT/PTT/INR & FDP
• Anticoagulant drugs
• LFT
• Metastases in Ca
• Increased ALP
• PSA
• Serum calcium, phosphate, & uric acid
• Urine
• Microscopy
• Pus cells and organisms in infection
• Casts in nephritis
• Culture
• To identify organism
• If no active bleed
• IVP
• Filling defects in bladder
• Kidney: shows stones
• Back pressure of kidneys in BPH
• Cystoscopy
• Bladder CA and biopsy
• Abdominal ultrasound
• Kidney mass/polycystic kidney disease
• Calculi in bladder
• If bleeding
• Catheterise
• Irrigate bladder
• Cystoscopy

• Fluid resuscitate if necessary
• Treat underlying condition
• Stones
• Pain relief
• 90% will pass
• Increase fluid intake (2L a day minimum)
• Change the precipitating diet (dairy/red meat/tea/red wine)

• 
  
• Nephrolithotomy(PCNL)/pyelolithotomy
• Lithotripsy (ESWL)
• Note – Urethral stones are a surgical emergency: Urethrotomy
• UTI
• Antibiotic and then treat underlying cause e.g. stones, BPH
• Bladder CA
• Transurethral resection of the bladder (transurethral cystectomy)
• Radical cystectomy and chemotherapy
• BPH
• Medical
• Proscar (Finasteride)
• Inhibits 5 Alpha Reductase
• Alpha blockers
• Prazosin
• Relaxes prostatic smooth muscle

• Urinary retention
• Hydronephrosis
• UTI’s
• Severe symptoms

Category: Surgery Notes