Haematuria Flashcards
Presentation of loin discomfort and macroscopic haematuria
The presentation of loin discomfort and macroscopic haematuria is highly suggestive of malignancy in the renal tract
Investigation of haematuria
Cystology checks for lower urinary tract (bladder) transitional cell cancer
USS is the basic screening test for a renal cell cancer
In most centres, CT urogram (to include post contrast sequence) has replaced USS/KUB x-ray for haematuria investigation, especially in macroscopic bleeding where tumour risk is high
Basically:
CT urogram/ CT KUB
+
Flexible cystoscopy (usually a week after, if they’ve been admitted)
When is CT KUB vs CT urogram used.
A NON-contrast CT KUB is used to investigate suspected urolithiasis, flank pain and haematuria
Urography (CT-IVU), which uses x-rays, is used in combination with CT KUB in investigation of haematuria (best for urinary tract cancer).
What is the investigation oh choice for haematuria
CT urogram OR KUB
+
Flexible cystoscopy (which is much better for bladder cancer)
If someone presents with copious frank haematuria, what is the immediate management
You want to resuscitate if necessary, wash out clots.
Then send home, and bring back in for flexible cystoscopy and scans.
Gold standard radiological investigation of renal stones
USS may be enough (but don’t show up stones in the ureter. Only show up hydronephrosis and stones in the kidney)
Non-contrast CT KUB is gold standard
Once there is confirmed diagnosis of kidney tumour, what investigations are necessary
The primary investigations would’ve been CT KUB/IV urogram and cystoscopy.
Now biopsy and staging are needed.
Biopsy is performed via ureteroscopy, and there should also be contralateral examination to exclude a small lesion. CT urogram is used for local staging to show the tumour extent, nodal status in para-aortic region.
Lung staging is also needed (CT chest).
Where do most transitional cell carcinomas occur
Most TCC’s occur in the bladder and synchronous (occuring at the same time) and metachronous (occuring later) lesions are common within the bladder, so cystoscopic follow up is needed for several years in moderately or poorly differentiated tumours.
Who is at risk of TCC
Along with smokers, aniline dye workers and analgesic abusers (phenacetin) are also at risk of TCC
T/F chronic stones in the kidney is a RF for TCC
F
Chronic stones in the urinary tract can cause squamous carcinoma.
Investigations for suspected kidney stones
USS KUB FIRST! Up to 80 per cent of renal stones are visible on ultrasound.
It isn’t that good at differentiating the types of stones.
IVU is more useful for detecting obstructions, but US should be done first.
CT scan issuperior to IVU and US and can differentiate 99% of renal stones. But radiation risk to patient makes investigation much more invasive.
What is the classic triad of renal cancer
The classic triad of flank pain, visible haematuria, and palpable abdominal mass is rare and correlates with aggressive histology and advanced disease.
How would you differentiate haematuria from a renal calculus vs due to a cancer
lthough renal colic secondary to a calculus is likely to cause haematuria, weight loss would not be expected.
Useful first investigation in the case of haematuria
Renal tract ultrasound.
It can diagnose renal tumours (but not sensitive for bladder cancer, and is likely to overlook a small transitional cell cancer).
Also, up to 80% of stones are visible on ultrasound.
What investigation would be needed if you suspect urological malignancy but the renal tract USS is negative
Renal tract USS is not sensitive for bladder tumours, and is likely to overlook a small transitional cell cancer.
Consequently, cystoscopy will be needed if the ultrasound is negative.
