Investigations

Question 1

What investigations would you do for painless haematuria?

Answer 1

• MSU (to rule out infection)
• U+E (to investigate renal disease)
• Flexible cystoscopy (to rule out bladder tumour)
• CT urogram (to exclude renal and ureteric tumours and stone disease)
• Serum PSA (prostate cancer)

Question 2

What investigations are done for haematuria?

Answer 2

• FBC
• U+E
• PSA
• Urine - MSU + PCR
• Renal tract ultrasound
• Flexible cystoscopy
• CT scan

Question 3

What are the differential diagnoses of haematuria and loin pain?

Answer 3

• Renal stone disease
• Renal tumours
• Infection
• Trauma
• Enlarged kidneys e.g. PCKD or obstruction
• Glomerular haematuria (IgA nephropathy)

Question 4

What would a history need to know about haematuria?

Answer 4

• Ask about colour
• Pain - colic, dull ache
• Fevers
• Weight loss
• Smoking
• Occupational exposure e.g. dyes
• Medication e.g. aspirin, NSAIDs, cyclophosphamide
• PMH (HTN, TB, procedures)
• FH (ADPKD etc)
• Examination e.g. flank mass, PR exam

Question 5

What investigation results would there be for glomerular haematuria?

Answer 5

• Proteinuria
• Renal impairment
• HTN
• Dysmorphic red cells/red cell casts
• Renal biopsy

Question 6

What is the criteria for being investigated with haematuria?

Answer 6

• Patients over 45 with microscopic haematuria should have a cystoscopy and renal ultrasound scan
• Patients aged under 45 with macroscopic haematuria in the absence of infection require cystoscopy and upper tract imaging
• Patients under 45 with microscopic haematuria only require renal imaging if they have increased urinary frequency and urgency. If loin pain then non-contrast CT to rule out stones.

Question 7

What investigations would be done for a UTI?

Answer 7

• Urine dip/MSU (nitrites, leucocytes, blood and protein suggest infection)
• MSU sample sent for microscopy

Question 8

What investigations would be done for pyelonephritis?

Answer 8

• Urine dip
• Blood cultures
• MSU
• UUT CT or ultrasound (to exclude pyonephrosis)

Question 9

What investigations would be done for complicated UTIs?

Answer 9

• Outpatient cystoscopy
• US or CT scan or UUT
• Male - bladder ultrasound scan to exclude chronic urinary retention

Question 10

What is the staging of bladder cancer?

Answer 10

Stage pTa: tumour cells confined to epithelium
Stage cis: aggressive cells confined to epithelium, usually flat tumour
Stage T1: tumour cells in sub-epithelial connective tissue
Stage T2/3: tumour cells in bladder wall muscle
Stage T4: tumour cells in adjacent organs such as prostate or uterus

Question 11

What tests would be done to investigate bladder cancer?

Answer 11

• Cystoscopy with biopsy is diagnostic
• Urine: microscopy/cytology
• CT urogram: diagnostic and provides staging
• MRI and lymphangiography (may show pelvic lymph nodes)
• TURBT: (diagnostic and treatment) tumours scrapped away from bladder using cystoscope

Question 12

What is the normal score for PSA antigen?

Answer 12

• <4ng/ml

- <4.5ng/ml in men aged 60-69

Question 13

What tests would be done for prostate cancer?

Answer 13

• PSA antigen
• MSU
• U+E
• US
• Transurethral US + biopsy
• PR exam

Question 14

What is the staging for prostate cancer?

Answer 14

• Low risk <10ng/ml + gleason score <6 + T1 to T2a
• Intermediate risk 10-20ng/ml OR gleason score 7 OR T2b
• High risk >20ng/ml OR 8-10 OR >T2c