ACUTE HEMATURIA

Question 1

DDx: Painful

Answer 1

Trauma: Urethral, Bladder, Ureteral, Kidney Injury, post procedural
Infectious: Prostatitis, UTI
Structural: Obstructive, stone

Question 2

DDx: Painless

Answer 2

Anticoagulation
Acute Glomerulonephritis
BPH
Bladder Cancer
Renal Cell Carcinoma

Question 3

Drugs / Food that cause red-coloured urine without hematuria

Answer 3

Pyridium
Nitrofurantoin
Rifampin
Choroquine
Iodine
Bromide
Food Colouring
Foods: Beets, Berries, Rhubarb

Question 4

Risk factors for malignancy

Answer 4

Age > 40
Male (PPV 22.1% with gross hematuria)
PMHx: Aniline Dyes, Benzene, Pelvic Radiation
Tobacco Smoke, Excessive use of analgesics

Question 5

Investigations

Answer 5

CBC
Electrolytes
PT, PTT, INR
Group & Screen
Creatinine
Urea
U/A & Culture
U/S KUB or CT Spiral (non contrast) if calculus, neoplasm or trauma suspected

Question 6

Management / Disposition

Answer 6

CBI until fluid runs clear

Catheter can be removed after the urine is clear

If patient is in retention with severe hematuria, or with history of clots - irrigate the bladder with a 24-26F 3-way catheter or a whistle tip catheter

Consult urology if manual irrigation and CBI not successful and consider further imaging studies

Arrange for urology follow up if risk factors for malignancy or reversible causes not found

Question 7

Clot Extraction Procedure

Answer 7

Pour 1-2 L of sterile normal saline in a sterile tray

Using a 60 cc irrigation syringe attached to the drainage port (i.e. the largest port), irrigate the catheter and bladder with 60 cc of sterile normal saline at at time, extracting clots and the 60 cc of NS with each irrigation

Several irrigations are often required to remove all clots

Irrigate until the output is completely void of clots for several irrigations