This document discusses the evaluation of hematuria from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It defines hematuria and describes its classification. Potential causes of hematuria are outlined, including urinary tract infections, kidney stones, trauma, exercise, and tumors. The evaluation of hematuria involves examination of the urine, including a dipstick test and microscopic analysis to characterize the red blood cells. Further tests may include imaging like ultrasound, CT, cystoscopy and renal biopsy to identify the source and cause of the bleeding. The document distinguishes between glomerular and non-glomerular causes based on urine characteristics.
This document discusses hematuria, or the presence of blood in the urine. Evaluation is warranted when hematuria is present, as it can be a sign of medical or urological issues. An initial workup includes a medical history, physical exam, urine analysis, and urine microscopy. Further imaging with ultrasound, CT scan, or cystoscopy may be used to investigate the urinary tract for causes like cancer, stones, infections, or structural abnormalities. For high risk patients, especially those older than 40 or with a history of smoking, a cystoscopy and urine cytology are recommended to screen for bladder cancer. Most cases of asymptomatic microscopic hematuria remain unexplained despite a full urological evaluation.
Testicular torsion refers to twisting of the spermatic cord and loss of blood supply to the testicle. It is a urological emergency as early diagnosis and treatment are needed to save the testicle. Ultrasound with Doppler is the primary imaging method and shows absent or decreased blood flow in the affected testicle compared to the normal side. Prompt surgical detorsion and orchioplexy are the definitive treatments.
Renal colic is a sudden, severe, dull pain that originates in the costovertebral angle and may radiate to the groin or abdomen. It is caused by obstruction of the ureter, usually by a kidney stone. Patients experience intermittent, colicky pain that is exacerbated by movement and relieved briefly by analgesics. Examination may reveal abdominal tenderness over the kidney area. Investigations include urinalysis, kidney imaging tests like ultrasound or CT scan to detect stones. Treatment focuses on pain relief, increasing fluid intake, and allowing stones to pass spontaneously when possible. Surgery is considered for larger stones or if conservative measures fail.
This document provides an overview of hematuria and glomerular causes of hematuria. It defines macroscopic and microscopic hematuria and discusses various glomerular diseases that can cause hematuria including IgA nephropathy, Alport syndrome, thin basement membrane disease, post-infectious glomerulonephritis, and Henoch–Schönlein purpura. It describes the clinical presentations, pathologies, diagnoses, and treatments of these conditions. Key investigations for glomerular hematuria are outlined.
Hematuria, or blood in the urine, can be caused by diseases of the urinary system or other systemic disorders. It is classified as microscopic or gross based on visibility, and as early, terminal, or diffuse based on timing during urination. Common causes include glomerular diseases, infections, cancers, trauma, and stones. Diagnosis involves urinalysis, microscopy, imaging, and sometimes kidney biopsy. Treatment focuses on the underlying condition causing the hematuria. Prognosis depends on associated clinical or laboratory abnormalities, with isolated microscopic hematuria generally having a good prognosis.
Hematuria refers to the presence of blood in the urine. A diagnosis requires red blood cells to be present in urine samples obtained at least a week apart. Hematuria can be classified as microscopic or macroscopic, intermittent or persistent, and by its location in the urinary tract. Potential causes include glomerular disease, tumors, infections, vascular abnormalities, stones and trauma. Evaluation involves urinalysis, urine culture, imaging tests like ultrasound and CT urography, and cystoscopy depending on risk factors. Treatment focuses on the underlying cause if identified, while asymptomatic microscopic hematuria often requires monitoring without intervention.
Dr. Abdellatif Zayed discusses various types of genitourinary trauma including renal, ureteral, bladder, and urethral injuries. Renal injuries are most commonly caused by blunt trauma from car accidents and are typically minor. Ureteral injuries require surgical repair depending on the location of the injury. Bladder injuries can be intraperitoneal, extraperitoneal, or a combination and are treated with exploration and repair or catheterization. Urethral injuries involve the anterior or posterior urethra and are managed with suprapubic catheterization and delayed repair when possible to reduce complications.
This document provides an overview of bladder anatomy, function, and bladder outlet obstruction. It describes the key parts of the bladder including relations to other organs. Normal micturition and factors that assist storage are explained. Causes of bladder outlet obstruction include anatomical and functional issues. Common symptoms include hesitancy, weak stream, and urinary tract infections. Investigations help locate the site of obstruction and assess kidney and bladder function.
This document discusses hematuria, or the presence of blood in the urine. Evaluation is warranted when hematuria is present, as it can be a sign of medical or urological issues. An initial workup includes a medical history, physical exam, urine analysis, and urine microscopy. Further imaging with ultrasound, CT scan, or cystoscopy may be used to investigate the urinary tract for causes like cancer, stones, infections, or structural abnormalities. For high risk patients, especially those older than 40 or with a history of smoking, a cystoscopy and urine cytology are recommended to screen for bladder cancer. Most cases of asymptomatic microscopic hematuria remain unexplained despite a full urological evaluation.
Testicular torsion refers to twisting of the spermatic cord and loss of blood supply to the testicle. It is a urological emergency as early diagnosis and treatment are needed to save the testicle. Ultrasound with Doppler is the primary imaging method and shows absent or decreased blood flow in the affected testicle compared to the normal side. Prompt surgical detorsion and orchioplexy are the definitive treatments.
Renal colic is a sudden, severe, dull pain that originates in the costovertebral angle and may radiate to the groin or abdomen. It is caused by obstruction of the ureter, usually by a kidney stone. Patients experience intermittent, colicky pain that is exacerbated by movement and relieved briefly by analgesics. Examination may reveal abdominal tenderness over the kidney area. Investigations include urinalysis, kidney imaging tests like ultrasound or CT scan to detect stones. Treatment focuses on pain relief, increasing fluid intake, and allowing stones to pass spontaneously when possible. Surgery is considered for larger stones or if conservative measures fail.
This document provides an overview of hematuria and glomerular causes of hematuria. It defines macroscopic and microscopic hematuria and discusses various glomerular diseases that can cause hematuria including IgA nephropathy, Alport syndrome, thin basement membrane disease, post-infectious glomerulonephritis, and Henoch–Schönlein purpura. It describes the clinical presentations, pathologies, diagnoses, and treatments of these conditions. Key investigations for glomerular hematuria are outlined.
Hematuria, or blood in the urine, can be caused by diseases of the urinary system or other systemic disorders. It is classified as microscopic or gross based on visibility, and as early, terminal, or diffuse based on timing during urination. Common causes include glomerular diseases, infections, cancers, trauma, and stones. Diagnosis involves urinalysis, microscopy, imaging, and sometimes kidney biopsy. Treatment focuses on the underlying condition causing the hematuria. Prognosis depends on associated clinical or laboratory abnormalities, with isolated microscopic hematuria generally having a good prognosis.
Hematuria refers to the presence of blood in the urine. A diagnosis requires red blood cells to be present in urine samples obtained at least a week apart. Hematuria can be classified as microscopic or macroscopic, intermittent or persistent, and by its location in the urinary tract. Potential causes include glomerular disease, tumors, infections, vascular abnormalities, stones and trauma. Evaluation involves urinalysis, urine culture, imaging tests like ultrasound and CT urography, and cystoscopy depending on risk factors. Treatment focuses on the underlying cause if identified, while asymptomatic microscopic hematuria often requires monitoring without intervention.
Dr. Abdellatif Zayed discusses various types of genitourinary trauma including renal, ureteral, bladder, and urethral injuries. Renal injuries are most commonly caused by blunt trauma from car accidents and are typically minor. Ureteral injuries require surgical repair depending on the location of the injury. Bladder injuries can be intraperitoneal, extraperitoneal, or a combination and are treated with exploration and repair or catheterization. Urethral injuries involve the anterior or posterior urethra and are managed with suprapubic catheterization and delayed repair when possible to reduce complications.
This document provides an overview of bladder anatomy, function, and bladder outlet obstruction. It describes the key parts of the bladder including relations to other organs. Normal micturition and factors that assist storage are explained. Causes of bladder outlet obstruction include anatomical and functional issues. Common symptoms include hesitancy, weak stream, and urinary tract infections. Investigations help locate the site of obstruction and assess kidney and bladder function.
Hematuria for undergraduates
this is a presentation i prepared for medical students about hematuria, hope u like it
for more urology resources visit:
www.uronotes2012.blogspot.com
Priapism is a prolonged, unwanted erection that continues hours beyond sexual stimulation. There are two main types: ischemic (low-flow) priapism which is painful and involves little blood flow out of the penis, and non-ischemic (high-flow) priapism which is painless and involves an abnormal connection allowing high arterial inflow. Ischemic priapism is a medical emergency requiring aspiration of blood from the penis and injection of medications to induce detumescence within 4-6 hours to prevent permanent erectile dysfunction. Treatment options depend on duration and include aspiration, intracavernosal injections of medications, or surgical shunting if conservative measures fail.
1) The document provides information on the evaluation and management of bleeding per rectum (BPR). It discusses the history, physical exam, differential diagnoses, investigations and treatment options for common causes of BPR.
2) Common causes of BPR include hemorrhoids, anal fissures, colorectal polyps, inflammatory bowel disease, diverticular disease, and colorectal cancers. The history can help determine if the bleeding is from distal or proximal lesions.
3) Physical exam involves digital rectal exam to feel for masses or other abnormalities. Initial investigations include labs, endoscopy, and imaging. Treatment depends on the underlying cause but may include medications, procedures like banding or surgery.
Approach to Hematuria including:
Definition of Hematuria.
Pathophysiology of Hematuria.
Differential Diagnosis of Red Urine.
Causes of Hematuria.
Approach to a patient with Hematuria.
Diagnostic Algorithms.
Management and Disposition.
HELLO FRIENDS HERE CAUSES OF HEMATURIA IS HERE MANAGEMENT IN NEXT PRESENTATION ...YOU CAN SEE AND SUBSCRIBE OVER YOU TUBE ...LEARN UROLOGY IS CHANNEL NAME
FOLLOW THE YOU TUBE CHANNEL FOR FUTURE UROLOGY VIDEO
https://www.youtube.com/channel/UCINcUe475Y3c3BvXHvZ8wEw
This document provides an approach to evaluating hematuria, or blood in the urine. It defines hematuria and discusses distinguishing it from pigmenturia or hemoglobinuria/myoglobinuria. Significant hematuria is described as more than 3 red blood cells per high power field on 3 urine analyses or a single analysis with over 100 red blood cells or gross hematuria. A history and physical exam can provide clues to the source and causes of hematuria. Additional testing includes urine analysis, blood tests, imaging and potentially renal biopsy. Common causes include stones, tumors, infections, bleeding disorders and glomerulonephritis. An algorithm is provided outlining evaluation and management based on urine findings.
The document provides guidelines for evaluating a patient presenting with hematuria. It begins with terminology and background on gross versus microscopic hematuria. Common causes are discussed including infection, stones, trauma, and tumors. The evaluation involves taking a thorough history, physical exam, urinalysis, and based on risk factors, further tests may include renal imaging, cystoscopy, or nephrology referral. The goal is to identify any underlying renal disease or urologic malignancy as the cause of the hematuria.
This document discusses bladder outlet obstruction (BOO) and its causes such as benign prostatic hyperplasia (BPH). It describes the primary and long term effects of BOO on the bladder, including decreased urinary flow rates and increased voiding pressures. For BPH, it notes the causes include hyperplasia of the prostate gland that typically begins in the third decade. The document outlines the diagnosis, evaluation and treatment of BOO, including medical management with medications like alpha blockers and 5-alpha reductase inhibitors, as well as surgical treatments like transurethral resection of the prostate (TURP).
Fournier's gangrene is a necrotizing fasciitis of the genital region that can be caused by various urogenital, anorectal, cutaneous or other infections. It is characterized by pain, swelling and skin necrosis, and can progress rapidly without treatment. The infection involves multiple types of bacteria and causes tissue death through vascular thrombosis. Aggressive surgical debridement and broad-spectrum antibiotics are needed to treat the infection and prevent high mortality rates.
Acute mesenteric ischemia is a life-threatening condition caused by interrupted blood flow to the intestines. It has a high mortality rate of 60-80% if not treated promptly. The document discusses the definition, causes, clinical presentation, diagnostic tests and management of acute mesenteric ischemia. Key diagnostic tests include bloodwork, abdominal imaging like CT angiography and angiography. Treatment involves fluid resuscitation, antibiotics, stopping vasoconstrictors, and often emergency surgery to revascularize the intestines or resect non-viable bowel segments. Prompt diagnosis and treatment are critical given the rapid progression of intestinal tissue damage from ischemia.
This document discusses varicoceles, which are dilated and tortuous veins in the pampiniform plexus that commonly occur in the left testicle. Varicoceles are a common cause of male infertility and are often treated with varicocelectomy surgery to ligate the veins. The document describes the anatomy, causes, symptoms, grading, investigations, and surgical and non-surgical treatment options for varicoceles.
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testicle. It most commonly affects adolescent boys and young men under age 25. Without prompt surgical intervention to untwist the cord within 6-12 hours, the testicle will become necrotic. Diagnosis involves physical exam findings like a high-riding, swollen testicle with absent cremasteric reflex as well as Doppler ultrasound showing reduced or absent blood flow. Immediate orchiopexy is needed to save the testicle from necrosis and allow for potential future fertility.
This document provides information about testicular cancers, including:
- Testicular cancer accounts for 1% of cancers in males and is highly curable when detected early, often affecting young men.
- The testis has blood supply from the testicular artery and drains into the pampiniform plexus and internal spermatic veins. Lymphatic drainage is to retroperitoneal lymph nodes.
- The majority (95%) are germ cell tumors, including seminomas and non-seminomas. Staging involves tumor markers, imaging scans, and lymph node dissection. Treatment depends on the type and stage but may include surgery, chemotherapy, and radiation therapy.
This document provides an overview of penile fracture, including relevant anatomy, causes, clinical presentation, diagnosis, treatment options, and postoperative care. It begins with an outline of the topics covered. The main points are: penile fracture involves a rupture of the corpus cavernosum during erection, most common causes are sexual intercourse and trauma from bending, patients experience pain, swelling and detumescence, diagnosis is usually clinical but imaging can help, and surgical repair within 24 hours has the best outcomes and aims to repair tears while preventing erectile dysfunction and abnormal healing.
This document discusses obstructive jaundice, providing definitions, pathophysiology, effects on various body systems, etiology, history and examination findings, laboratory investigations, imaging modalities, and causes of biliary obstruction. It defines obstructive jaundice as a failure of bile to reach the intestine due to mechanical obstruction. Pathophysiological changes include bile duct dilation, hepatic fibrosis, and portal hypertension. Causes include gallstones, strictures, tumors, and congenital anomalies. A thorough history, physical exam, and lab tests can localize the level and cause of obstruction, while imaging modalities like ultrasound and MRCP can identify and characterize obstructive lesions.
This document outlines a seminar on gall bladder and biliary pathologies. It begins with an overview of gall bladder anatomy and functions. It then discusses common pathologies like cholelithiasis, cholecystitis, cholangitis, and sclerosing cholangitis. Congenital abnormalities like biliary atresia and choledochal cyst are described. Finally, it covers tumors of the bile duct, distinguishing between benign and malignant types.
Urological symptoms can involve pain, changes to urination, changes in urine appearance, or abnormalities of the male genitalia. A complete history divides into chief complaint, history of present illness, past medical history, family history, and review of systems. Physical exam includes inspection and palpation of the abdomen with specific examination of the kidneys, bladder, and genitalia. Common urological complaints involve sites of pain, irritative urinary symptoms, obstructive symptoms, incontinence, hematuria, and sexual or genital abnormalities.
Asymptomatic bacteriuria occurs when significant bacterial growth is detected in a urine culture without any urinary symptoms. It is more common in women than men and people with urinary catheters. While usually harmless, it can increase risks for kidney infections in pregnancy or for those with diabetes, kidney stones, or transplants. Treatment is recommended for high-risk groups and before some procedures to prevent complications. Proteinuria and hematuria in pregnancy can be caused by infections, preeclampsia, trauma, or underlying kidney diseases and require evaluation and management depending on the underlying cause.
This document provides guidelines for the evaluation and management of hematuria from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the classification, timing, differential diagnosis, and evaluation of hematuria. The evaluation includes history, physical exam, urinalysis, urine culture if indicated, renal function testing, cystoscopy, and imaging such as CT urogram. The goal of evaluation is to identify any underlying causes of hematuria such as infection or malignancy. Close follow up is recommended depending on the diagnosis and persistence of microscopic hematuria.
The document discusses emphysematous pyelonephritis (EPN), a severe necrotizing infection of the renal parenchyma that causes gas accumulation. EPN most often occurs in persons with uncontrolled diabetes, especially women. It requires prompt diagnosis using CT scan and treatment with IV antibiotics and percutaneous drainage to drain abscesses. Factors like altered mental status, thrombocytopenia and elevated creatinine indicate higher risk cases that may require emergency nephrectomy. With aggressive treatment, reported mortality has improved but remains at 20-25%.
Hematuria for undergraduates
this is a presentation i prepared for medical students about hematuria, hope u like it
for more urology resources visit:
www.uronotes2012.blogspot.com
Priapism is a prolonged, unwanted erection that continues hours beyond sexual stimulation. There are two main types: ischemic (low-flow) priapism which is painful and involves little blood flow out of the penis, and non-ischemic (high-flow) priapism which is painless and involves an abnormal connection allowing high arterial inflow. Ischemic priapism is a medical emergency requiring aspiration of blood from the penis and injection of medications to induce detumescence within 4-6 hours to prevent permanent erectile dysfunction. Treatment options depend on duration and include aspiration, intracavernosal injections of medications, or surgical shunting if conservative measures fail.
1) The document provides information on the evaluation and management of bleeding per rectum (BPR). It discusses the history, physical exam, differential diagnoses, investigations and treatment options for common causes of BPR.
2) Common causes of BPR include hemorrhoids, anal fissures, colorectal polyps, inflammatory bowel disease, diverticular disease, and colorectal cancers. The history can help determine if the bleeding is from distal or proximal lesions.
3) Physical exam involves digital rectal exam to feel for masses or other abnormalities. Initial investigations include labs, endoscopy, and imaging. Treatment depends on the underlying cause but may include medications, procedures like banding or surgery.
Approach to Hematuria including:
Definition of Hematuria.
Pathophysiology of Hematuria.
Differential Diagnosis of Red Urine.
Causes of Hematuria.
Approach to a patient with Hematuria.
Diagnostic Algorithms.
Management and Disposition.
HELLO FRIENDS HERE CAUSES OF HEMATURIA IS HERE MANAGEMENT IN NEXT PRESENTATION ...YOU CAN SEE AND SUBSCRIBE OVER YOU TUBE ...LEARN UROLOGY IS CHANNEL NAME
FOLLOW THE YOU TUBE CHANNEL FOR FUTURE UROLOGY VIDEO
https://www.youtube.com/channel/UCINcUe475Y3c3BvXHvZ8wEw
This document provides an approach to evaluating hematuria, or blood in the urine. It defines hematuria and discusses distinguishing it from pigmenturia or hemoglobinuria/myoglobinuria. Significant hematuria is described as more than 3 red blood cells per high power field on 3 urine analyses or a single analysis with over 100 red blood cells or gross hematuria. A history and physical exam can provide clues to the source and causes of hematuria. Additional testing includes urine analysis, blood tests, imaging and potentially renal biopsy. Common causes include stones, tumors, infections, bleeding disorders and glomerulonephritis. An algorithm is provided outlining evaluation and management based on urine findings.
The document provides guidelines for evaluating a patient presenting with hematuria. It begins with terminology and background on gross versus microscopic hematuria. Common causes are discussed including infection, stones, trauma, and tumors. The evaluation involves taking a thorough history, physical exam, urinalysis, and based on risk factors, further tests may include renal imaging, cystoscopy, or nephrology referral. The goal is to identify any underlying renal disease or urologic malignancy as the cause of the hematuria.
This document discusses bladder outlet obstruction (BOO) and its causes such as benign prostatic hyperplasia (BPH). It describes the primary and long term effects of BOO on the bladder, including decreased urinary flow rates and increased voiding pressures. For BPH, it notes the causes include hyperplasia of the prostate gland that typically begins in the third decade. The document outlines the diagnosis, evaluation and treatment of BOO, including medical management with medications like alpha blockers and 5-alpha reductase inhibitors, as well as surgical treatments like transurethral resection of the prostate (TURP).
Fournier's gangrene is a necrotizing fasciitis of the genital region that can be caused by various urogenital, anorectal, cutaneous or other infections. It is characterized by pain, swelling and skin necrosis, and can progress rapidly without treatment. The infection involves multiple types of bacteria and causes tissue death through vascular thrombosis. Aggressive surgical debridement and broad-spectrum antibiotics are needed to treat the infection and prevent high mortality rates.
Acute mesenteric ischemia is a life-threatening condition caused by interrupted blood flow to the intestines. It has a high mortality rate of 60-80% if not treated promptly. The document discusses the definition, causes, clinical presentation, diagnostic tests and management of acute mesenteric ischemia. Key diagnostic tests include bloodwork, abdominal imaging like CT angiography and angiography. Treatment involves fluid resuscitation, antibiotics, stopping vasoconstrictors, and often emergency surgery to revascularize the intestines or resect non-viable bowel segments. Prompt diagnosis and treatment are critical given the rapid progression of intestinal tissue damage from ischemia.
This document discusses varicoceles, which are dilated and tortuous veins in the pampiniform plexus that commonly occur in the left testicle. Varicoceles are a common cause of male infertility and are often treated with varicocelectomy surgery to ligate the veins. The document describes the anatomy, causes, symptoms, grading, investigations, and surgical and non-surgical treatment options for varicoceles.
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testicle. It most commonly affects adolescent boys and young men under age 25. Without prompt surgical intervention to untwist the cord within 6-12 hours, the testicle will become necrotic. Diagnosis involves physical exam findings like a high-riding, swollen testicle with absent cremasteric reflex as well as Doppler ultrasound showing reduced or absent blood flow. Immediate orchiopexy is needed to save the testicle from necrosis and allow for potential future fertility.
This document provides information about testicular cancers, including:
- Testicular cancer accounts for 1% of cancers in males and is highly curable when detected early, often affecting young men.
- The testis has blood supply from the testicular artery and drains into the pampiniform plexus and internal spermatic veins. Lymphatic drainage is to retroperitoneal lymph nodes.
- The majority (95%) are germ cell tumors, including seminomas and non-seminomas. Staging involves tumor markers, imaging scans, and lymph node dissection. Treatment depends on the type and stage but may include surgery, chemotherapy, and radiation therapy.
This document provides an overview of penile fracture, including relevant anatomy, causes, clinical presentation, diagnosis, treatment options, and postoperative care. It begins with an outline of the topics covered. The main points are: penile fracture involves a rupture of the corpus cavernosum during erection, most common causes are sexual intercourse and trauma from bending, patients experience pain, swelling and detumescence, diagnosis is usually clinical but imaging can help, and surgical repair within 24 hours has the best outcomes and aims to repair tears while preventing erectile dysfunction and abnormal healing.
This document discusses obstructive jaundice, providing definitions, pathophysiology, effects on various body systems, etiology, history and examination findings, laboratory investigations, imaging modalities, and causes of biliary obstruction. It defines obstructive jaundice as a failure of bile to reach the intestine due to mechanical obstruction. Pathophysiological changes include bile duct dilation, hepatic fibrosis, and portal hypertension. Causes include gallstones, strictures, tumors, and congenital anomalies. A thorough history, physical exam, and lab tests can localize the level and cause of obstruction, while imaging modalities like ultrasound and MRCP can identify and characterize obstructive lesions.
This document outlines a seminar on gall bladder and biliary pathologies. It begins with an overview of gall bladder anatomy and functions. It then discusses common pathologies like cholelithiasis, cholecystitis, cholangitis, and sclerosing cholangitis. Congenital abnormalities like biliary atresia and choledochal cyst are described. Finally, it covers tumors of the bile duct, distinguishing between benign and malignant types.
Urological symptoms can involve pain, changes to urination, changes in urine appearance, or abnormalities of the male genitalia. A complete history divides into chief complaint, history of present illness, past medical history, family history, and review of systems. Physical exam includes inspection and palpation of the abdomen with specific examination of the kidneys, bladder, and genitalia. Common urological complaints involve sites of pain, irritative urinary symptoms, obstructive symptoms, incontinence, hematuria, and sexual or genital abnormalities.
Asymptomatic bacteriuria occurs when significant bacterial growth is detected in a urine culture without any urinary symptoms. It is more common in women than men and people with urinary catheters. While usually harmless, it can increase risks for kidney infections in pregnancy or for those with diabetes, kidney stones, or transplants. Treatment is recommended for high-risk groups and before some procedures to prevent complications. Proteinuria and hematuria in pregnancy can be caused by infections, preeclampsia, trauma, or underlying kidney diseases and require evaluation and management depending on the underlying cause.
This document provides guidelines for the evaluation and management of hematuria from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the classification, timing, differential diagnosis, and evaluation of hematuria. The evaluation includes history, physical exam, urinalysis, urine culture if indicated, renal function testing, cystoscopy, and imaging such as CT urogram. The goal of evaluation is to identify any underlying causes of hematuria such as infection or malignancy. Close follow up is recommended depending on the diagnosis and persistence of microscopic hematuria.
The document discusses emphysematous pyelonephritis (EPN), a severe necrotizing infection of the renal parenchyma that causes gas accumulation. EPN most often occurs in persons with uncontrolled diabetes, especially women. It requires prompt diagnosis using CT scan and treatment with IV antibiotics and percutaneous drainage to drain abscesses. Factors like altered mental status, thrombocytopenia and elevated creatinine indicate higher risk cases that may require emergency nephrectomy. With aggressive treatment, reported mortality has improved but remains at 20-25%.
This document discusses the diagnosis and management of posterior urethral valves. It begins by defining PUV as a congenital obstructing membrane in the urethra that causes lower urinary tract obstruction. PUV is the most common cause of urinary outflow obstruction in pediatric patients and can lead to renal failure if not treated. The document then covers the pathophysiology, prenatal diagnosis, postnatal evaluation and various treatment approaches for PUV including endoscopic valve ablation, vesicostomy, and nephroureterectomy in severe cases.
This document discusses stricture urethra and its management. It provides details on the epidemiology, etiology, clinical evaluation and surgical options for urethral strictures. Key points include that bulbar strictures are the most common, iatrogenic causes have increased in prevalence, clinical evaluation involves uroflowmetry, retrograde urethrogram and cystoscopy, and surgical options range from dilation and direct visual internal urethrotomy for short strictures to various types of urethroplasty using grafts or flaps for longer or complex strictures.
Hematuria can be caused by many conditions affecting the kidneys and urinary tract. It is important to evaluate the patient based on symptoms, risk factors, physical exam, and lab/imaging tests to determine the etiology and develop a treatment plan. Gross or microscopic hematuria may indicate infections, cancers, stones, or glomerular diseases. Evaluation involves urinalysis, imaging like ultrasound or CT, and further tests based on findings. Goals of treatment are to ensure urine can drain, identify the cause, and provide follow-up care and management.
This document discusses various types of prostatitis including acute bacterial, chronic bacterial, and chronic pelvic pain syndrome. It provides details on the classification, symptoms, evaluation, and treatment of these conditions. Key points include the NIH classification system for prostatitis, risk factors and microbiology of acute bacterial prostatitis, diagnosis of chronic bacterial prostatitis using expressed prostatic secretions cultures, and treatment of conditions like prostatic abscess through drainage or surgery. The document is intended as an educational guide on prostatitis for medical professionals.
This document discusses emphysematous pyelonephritis (EPN), a rare necrotizing infection of the renal parenchyma that causes gas formation. It provides details on the typical presentation, risk factors, diagnosis and classification of EPN. The document is authored by professors and assistant professors from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It covers epidemiology, pathogenesis, clinical features, investigations including CT findings, classification systems for EPN, treatment approaches including antibiotics and percutaneous drainage, and outcomes.
This document provides information about urogynecological fistulas from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the different types of genitourinary fistulas including vesicovaginal fistula, their causes such as obstetric injuries or gynecological surgeries. Evaluation methods like cystoscopy and imaging are described. Conservative management and surgical repair techniques for fistulas via vaginal or abdominal approaches are outlined.
This document discusses the clinical features, prognostic factors, investigations and guidelines for diagnosis of renal cell carcinoma (RCC). It covers the typical presentations of RCC including incidental discovery, localized symptoms like flank pain, and symptoms of advanced disease. Investigations discussed include blood tests, CT, MRI, renal angiography and PET. Guidelines from AUA, EAU, NCCN and ESMO are summarized, emphasizing use of CT for diagnosis and staging, and recommending biopsy for small lesions before treatment.
This document discusses various categories of male infertility treatment. It covers common causes of male infertility like varicocele, cryptorchidism, endocrinopathies, and ejaculatory dysfunction. For each category, it describes the etiology, pathophysiology, evaluation, and treatment options. The treatment options discussed include varicocele repair, orchiopexy for cryptorchidism, hormone therapy for endocrinopathies, and assisted reproductive techniques for conditions affecting sperm production or delivery.
This document discusses various categories of male infertility treatment. It covers common causes of male infertility like varicocele, cryptorchidism, endocrinopathies and outlines treatment approaches. For varicocele, it describes indications for treatment, outcomes of repair including improved semen parameters and pregnancy rates. For cryptorchidism, it discusses detrimental effects on fertility and benefits of early orchiopexy. Overall, the document provides an overview of etiologies of male infertility and management strategies.
This document provides information about the Department of Urology at Government Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides definitions and principles of renal replacement therapy including dialysis and transplantation. It discusses indications for renal replacement therapy and covers various modalities like hemodialysis, peritoneal dialysis, vascular access and complications.
This document discusses urinary obstruction, including its pathophysiology, causes, effects on renal physiology and function, histological changes, clinical impact, and renal recovery after relief of obstruction. It provides an overview of how urinary obstruction can lead to permanent kidney damage depending on the severity, chronicity, and baseline kidney condition. Both unilateral and bilateral obstruction are examined, along with the triphasic response and changes in renal blood flow, filtration, and tubular transport that occur.
This document discusses vesico-enteric and vesico-uterine fistulae. Vesico-enteric fistulae most commonly result from diverticulitis and present with pneumaturia. Diagnosis is made using cystoscopy and CT scan. Repair involves single- or multi-stage procedures depending on factors like contamination. Vesico-uterine fistulae most often result from low segment cesarean sections and do not always cause incontinence. Management depends on fertility desires, with hysterectomy and bladder repair for those not wanting more children and uterine-sparing for others.
Dr. Sanjay R.P. and Dr. Rajendra Prasad chaired a discussion on the evaluation and management of hematuria. Hematuria is defined as the presence of red blood cells in urine and can be classified based on intensity, origin, relation to urination, etiology, and associated symptoms. Evaluation involves a history and physical exam to determine the cause and guide appropriate testing such as urine analysis, cystoscopy, imaging studies. For microscopic hematuria, initial evaluation includes risk assessment for malignancy and medical renal disease to guide further urologic or nephrologic evaluation if needed.
This document summarizes information about lichen sclerosus, a chronic skin condition that commonly affects the genital skin. It describes the signs and symptoms, risk factors like uncircumcision, pathophysiology involving fibrosis and hypoxia, association with autoimmune diseases and rare risk of squamous cell carcinoma. Histopathology shows epidermal atrophy, dermal fibrosis and lymphocytic infiltration. The document also discusses lichen sclerosus involvement of the urethra potentially leading to strictures, with the external urinary meatus involvement posing higher risk for progressive disease.
This document discusses benign bladder tumors and non-urothelial bladder malignancies. It provides information on various benign tumors of the bladder including epithelial metaplasia, leukoplakia, inverted papilloma, nephrogenic adenoma, leiomyoma, and inflammatory pseudotumor. It also discusses non-urothelial bladder malignancies such as squamous cell carcinoma, adenocarcinoma, small cell carcinoma, sarcoma, and others. Treatment options and characteristics of different tumor types are covered. The document is intended as an educational guide for medical professionals.
Rectal bleeding has many potential causes, both minor and major. Minor bleeding may be due to hemorrhoids or fissures, while more severe bleeding requires emergency treatment. In cases of massive bleeding, initial steps include admission to the hospital, insertion of IV lines, monitoring of vitals, and blood transfusions as needed to stabilize the patient. Further tests such as colonoscopy or angiography aim to locate the source of bleeding so it can be addressed through methods like cauterization or surgery. Surgical intervention may be needed if other measures do not stop severe or persistent bleeding.
This document describes the renogram procedure. It provides details on:
- The radiopharmaceuticals used, including 99mTc-DTPA, 99mTc-MAG3, and 99mTc-DMSA
- How the procedure is performed, including patient preparation, image acquisition, and time-activity curve analysis
- The roles of the radiopharmaceuticals in evaluating renal blood flow, glomerular filtration rate, and renal handling and excretion
- Factors that can affect the procedure such as hydration, medications, and kidney positioning
This document provides information about an X-ray KUB (kidneys, ureters, bladder) exam performed by the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It lists the moderators and their qualifications. It then discusses the history of X-rays, how they are produced, standard views, and how to systematically read an X-ray KUB. It describes how to assess technical quality and what to look for, including renal calcifications which are most commonly due to kidney stones. It also discusses mimics of urinary calcifications like gallstones.
This document provides information about a KUB (kidney, ureter, bladder) x-ray performed at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides details on the history, physics, techniques, anatomical landmarks, disorders, and interpretations of renal calculi, ureter, bladder, and other findings that can be seen on a KUB x-ray.
This document describes a voiding cystourethrogram (VCUG) conducted by the Department of Urology at GRH and KMC in Chennai, India. It lists the professors and assistant professors moderating the VCUG. The document provides details on the indications, techniques, and pediatric applications of VCUGs, focusing on evaluating conditions like vesicoureteral reflux, posterior urethral valves, bladder diverticula, and ectopic ureters. It compares VCUG to nuclear cystography and voiding sonography as diagnostic tools.
This document provides information about ultrasound use in urology. It discusses the history of ultrasound in urology from 1963 onwards. It then covers basic ultrasound principles including modes, probes, imaging planes and documentation. Applications to the kidney, bladder, prostate and testes are described. Common abnormalities like hydronephrosis, cysts, masses and infections are outlined. In summary, the document is an overview of ultrasound techniques and their use in evaluating the urinary tract and common urologic conditions.
The document provides information about urodynamics testing performed at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the professors and assistant professors who moderate the tests. It then describes the purpose and components of urodynamics testing, which involves a series of tests to evaluate urine storage and evacuation. The key components reviewed include uroflowmetry, measurement of post-void residual urine, cystometrogram, pressure flow studies, and videourodynamics. The document provides details on performing each test and interpreting the results.
This document provides an overview of MRI in urology, with a focus on MRI of the prostate. It discusses the moderators and professors of the department of urology. It then covers the basic principles of MRI, including magnetic field strength, radiofrequency pulses, T1/T2 weighting, and contrast agents. Applications of MRI for prostate imaging and prostate cancer detection are described, including T2-weighted imaging, diffusion-weighted imaging, and magnetic resonance spectroscopy. The PIRADS scoring system and assessment of extracapsular extension on MRI are also summarized.
This document provides information about intravenous urography (IVU), including its definition, history, indications, contraindications, technique, phases, and what is evaluated. Some key points:
- IVU involves injecting iodine contrast intravenously and taking x-ray images as it passes through the kidneys, ureters, and bladder. It was introduced in 1929 by American urologist Moses Swick.
- Indications include evaluating for ureteral obstruction, trauma, congenital anomalies, hematuria, infection, or uncontrolled hypertension. Contraindications include contrast allergy and renal impairment.
- The technique involves injecting contrast as a rapid bolus,
This patient presented with anterior urethral stricture and multiple abnormal connections (fistulas) between the prostate gland/urethra and the skin, resulting in urine leakage to the skin. Treatment will require surgical repair of the strictures and closure of all abnormal connections to restore normal urinary flow and continence.
This document provides information about intravenous urography (IVU), including:
- IVU involves injecting contrast media intravenously and imaging the kidneys, ureters, and bladder.
- It has indications like evaluating suspected obstruction, assessing integrity after trauma, and investigating hematuria or infection.
- Contraindications include contrast allergy and renal failure. Advantages include clearly outlining the urinary system, while disadvantages include need for contrast and radiation exposure.
- The document describes the IVU technique, expected timing of images, and what should be evaluated on the images.
- It also covers normal anatomy, types of contrast media, and abnormal findings that could be
This document discusses urinary extravasation, which is when urine leaks out of the urinary tract into other body cavities. It defines two types - superficial and deep extravasation. Superficial extravasation occurs above the perineal membrane and is usually caused by injuries to the penile urethra during instrumentation. Deep extravasation occurs below the perineal membrane due to injuries of the membranous urethra or extraperitoneal bladder from pelvic trauma. Management involves pain relief, antibiotics, suprapubic catheterization, and sometimes surgical exploration and drainage of collections.
This document provides information about urodynamic evaluation of voiding dysfunction. It discusses the history of urodynamics, aims, equipment used including catheters, flowmeters and EMG equipment. It describes how to conduct urodynamic evaluations including uroflowmetry, cystometrogram, and considerations for filling rate and medium. Key points covered are the indications for urodynamics, preparation of patients, types of equipment and how to interpret uroflow curves and cystometrogram measurements.
This document provides information about various tumor markers used in urology, including prostate-specific antigen (PSA) markers for prostate cancer screening and diagnosis, tumor markers for testicular cancer such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG), and urine-based markers for bladder cancer screening like NMP22 and BTA. It also discusses guidelines for PSA screening and interpretation, as well as clinical applications of different tumor markers for diagnosis, prognosis, monitoring treatment response, and detecting recurrence of urological cancers.
This document discusses transitional urology, which involves the planned movement of adolescents and young adults with chronic urological conditions from pediatric to adult-centered care. It provides an overview of common urological conditions seen in transitional urology, including spina bifida, bladder exstrophy, hypospadias, posterior urethral valves, vesicoureteral reflux, and pediatric genitourinary cancers. It also discusses specific issues in transitional urology like urinary tract infections in neurogenic/reconstructed bladders, troubleshooting continent catheterizable channels, risks of malignancy with augmentation cystoplasty, and presentation of BPH and pelvic organ prolapse in patients with neurogenic
This document provides information about retroperitoneal fibrosis (RPF), including its pathogenesis, clinical presentations, investigations, and management. RPF is characterized by extensive fibrosis in the retroperitoneum that can encase the aorta, vena cava, and ureters. Patients typically present with nonspecific symptoms like back pain, but late presentations can include urinary obstruction and vascular complications. Diagnosis is often made using CT or MRI imaging showing soft tissue surrounding retroperitoneal structures. Treatment involves medications like corticosteroids to reduce inflammation or surgical procedures to decompress the urinary system if obstructed.
The document describes urodynamic evaluation (UDE) performed in the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides an introduction to UDE. It then describes the various components of UDE including uroflowmetry, cystometry, pressure flow studies and videourodynamics. It outlines the procedure for setting up and performing UDE, and analyzes storage and voiding phases and parameters measured.
This document describes uroflowmetry - a noninvasive test used to evaluate urine flow. It discusses the normal and abnormal flow patterns seen in uroflowmetry and their clinical significance. Uroflowmetry provides parameters like maximum flow rate, average flow rate and voided volume. It can detect bladder outlet obstruction, detrusor underactivity or overactivity. However, pressure-flow studies are needed to precisely define lower urinary tract function. Uroflowmetry is useful for screening and monitoring treatment response, though invasive therapy should not be based on uroflowmetry alone per AUA guidelines.
Pathophysiology of pneumoperitoneum and complications of laproscopic surgeryGovtRoyapettahHospit
This document provides information about the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It lists the professors and assistant professors in the department and provides an introduction to laparoscopy. The rest of the document discusses the history of laparoscopy, choices of insufflation gas, physiological effects of pneumoperitoneum, and potential complications of laparoscopy procedures. It provides details on cardiovascular, respiratory, renal, and other organ system effects of increased abdominal pressure during laparoscopy. The document also outlines potential complications from veress needle placement, trocar insertion, insufflation, and electrosurgery and their management.
This document discusses the history and types of endoscopes used in urology. It describes rigid endoscopes which use a series of lenses to transmit images and how the rod lens system improved image quality. Flexible endoscopes transmit images using fiber optic bundles and have the advantage of being able to flex and access different areas. Newer digital endoscopes replace lenses with CCD chips to provide superior quality images electronically. The document outlines the benefits of different endoscope technologies and future trends including 3D imaging and wireless capabilities.
This document discusses various positioning techniques used in urological procedures. It describes the lithotomy, lateral decubitus, prone, supine, and Trendelenburg positions. For each position, it provides details on how to properly position the patient, including flexion angles, padding of pressure points, and risks of nerve injuries if not performed correctly. It aims to ensure patient safety and provide optimal surgical exposure while avoiding iatrogenic injuries during urological procedures.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
2. Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2
3. Hematuria
• Gross or Macroscopic or Visible-the single observation of visible urine
discoloration due to the presence of blood (> 2500 RBCs / μl)
• Microscopic - when the urine is visually normal in color but is found to contain
blood on chemical analysis or microscopic evaluation.
• Asymptomatic microhematuria (AMH) - is defined as, 3 or greater RBCs / HPF
on a properly collected urinary spun specimen in the absence of an obvious
benign cause. (single urinary specimen)
• Normal excretion rate is : 0.5 to 2 million RBCs/24 hr
3
Dept of Urology, GRH and KMC, Chennai.
4. • Cyclic hematuria- in women that is most prominent during
and shortly after menstruation, suggesting endometriosis
of the urinary tract.
• Sterile pyuria with hematuria- renal tuberculosis, analgesic
nephropathy and other interstitial diseases
• Loin pain-hematuria syndrome (LPHS)- (rare) a poorly
defined disorder; recurrent episodes of severe unilateral or
bilateral loin (flank) pain that were accompanied by gross
or microscopic hematuria with dysmorphic red cell features
suggesting a glomerular origin; associated with somatoform
disorders and use of OCPs. Affected patients usually have
normal kidney function.
4
Dept of Urology, GRH and KMC, Chennai.
5. • Exercise induced hematuria: Gross or microscopic
hematuria that occurs after strenuous exercise
and resolves with rest
•Direct trauma to the kidneys and/or bladder
may be responsible for the hematuria
•Renal ischemia due to shunting of blood to
exercising muscles
Evaluation for other causes of hematuria is
warranted if the hematuria persists well beyond
one week
5
Dept of Urology, GRH and KMC, Chennai.
6. Hematuria Dysuria syndrome: presence of Hematuria and
dysuria after Gastrocystoplasty, seen in 36% of the cases.
▪ 14% of patients required treatment with medications.
▪ signs and symptoms are most likely secondary to acid
irritation.
▪ It is imperative to achieve reliable urinary continence in
patients undergoing gastrocystoplasty because urinary
leakage may result in the exposure of the skin(meatal) to
gastric secretions and in gastric secretions that are poorly
diluted. Dilution is important
▪ respond well to H2 blockers and hydrogen ion pump
blockers.
▪ Bladder irrigation with baking soda may also be effective.
6
Dept of Urology, GRH and KMC, Chennai.
7. • Nutcracker syndrome hematuria: can cause both
microscopic and gross hematuria, primarily in children
(but also adults) in Asia .
usually asymptomatic but may be associated with left
flank pain; also been associated with orthostatic
proteinuria.
• Benign essential hematuria: no obvious source of
hematuria can be identified through conventional
studies. Frequent bouts of GH with clots and colic +
usual causes are small venous abnormalities/
hemangiomas. CT/MRI are initial studies but low yield;
Better seen on UT endoscopic inspection.
7
Dept of Urology, GRH and KMC, Chennai.
8. • - variable course of urethritis
• - blood spotting in prepubertal boys
• - hormonal factors combined with inflammation
• If normal phy.exam. & neg. urine C/S – no further
evaluation needed
• If stricture is suspected do cystoscopy & VCU
• REITER’s syndrome – arthritis, conjunctivitis
Idiopathic urethrorrhagia
8
Dept of Urology, GRH and KMC, Chennai.
9. WHAT to look FOR ?
• Gross or microscopic.
• Timing of hematuria: Initial or total or terminal.
• Associated loin pain.
• Presence or absence of clot
• Clot characteristics.
9
Dept of Urology, GRH and KMC, Chennai.
10. BASED ON TIMING
• Indicates the site of origin.
• Initial hematuria - arises from the
urethra ,secondary to
inflammation.
• Total hematuria – most common
anywhere from the bladder or
upper urinary tracts.
• Terminal hematuria- end of
micturition, secondary to
inflammation in the bladder neck,
trigone or prostatic urethra
10
Dept of Urology, GRH and KMC, Chennai.
11. Duration of Hematuria
• Transient Hematuria
Benign & without any obvious etiology in 39% of
young adults
• 8-9% of adults >50yr – malignancy
• Persistent Hematuria
Defined as three positive urinalyses, based on a
test strip and microscopic examination, over a 2 to
3 week period
• Microscopic – 5% malignancy • Macroscopic –
20% malignancy
11
Dept of Urology, GRH and KMC, Chennai.
12. ASSOCIATION WITH PAIN
• Due to inflammation or obstruction.
• Usually results from upper urinary tract hematuria with
obstruction of the ureters with clots.
12
Dept of Urology, GRH and KMC, Chennai.
13. Associated with CLOTS. ?
Clot indicates a more significant degree of hematuria.
Amorphous
signifies bladder or prostatic urethral origin.
vermiform (wormlike) clots
associated with flank pain signifies origin from upper
urinary tract with formation of vermiform clots within
the ureter.
13
Dept of Urology, GRH and KMC, Chennai.
14. Pathophysiology:
• Structural disruption in the integrity of
glomerular basement membrane caused by
inflammatory or immunologic processes
• Toxic disruptions of the renal tubules
• Mechanical erosion of mucosal surfaces in the
genitourinary tract
14
Dept of Urology, GRH and KMC, Chennai.
15. Characteristics of urine:
• Amount of urine: Reduced in AGN, ARF
• Clots in urine: Extraglomerular
• Frequency, Dysuria, recent enuresis : UTI
• Frothy urine: Suggests Proteinuria seen in
Glomerular diseases
15
Dept of Urology, GRH and KMC, Chennai.
16. Physical Examination Findings and Associated Causes of
Hematuria
Physical examination finding Cause of hematuria
General (systemic) examination
Severe dehydration Renal vein thrombosis
Peripheral edema Nephrotic syndrome, vasculitis
Cardiovascular system
Myocardial infarction Renal artery embolus or thrombus
Atrial fibrillation Renal artery embolus or thrombus
Hypertension Glomerulosclerosis with or without
proteinuria
Abdomen
Bruit Arteriovenous fistula
Genitourinary system
Enlarged prostate Urinary tract infection
Phimosis Urinary tract infection
Meatal stenosis Urinary tract infection
16
Dept of Urology, GRH and KMC, Chennai.
17. 1. Concurrent pyuria and dysuria, indicate UTI, may also occur with
bladder malignancy.
2. A recent URI, raise the possibility of either post infectious
glomerulonephritis or IgA nephropathy
3. A positive family history of renal disease give suspicion of
hereditary nephritis, polycystic kidney disease, Alports syndromes,
or sickle cell disease.
Clues from the history that point toward a specific
diagnosis
17
Dept of Urology, GRH and KMC, Chennai.
18. • 4. Unilateral flank pain radiating to the groin, suggesting
ureteral obstruction due to a calculus or blood clot, but
can occasionally be seen with malignancy. Flank pain that
is persistent or recurrent can also occur in the rare loin
pain hematuria syndrome.
• 5. Symptoms of prostatic obstruction in older men such as
hesitancy and dribbling. The cellular proliferation in BPH is associated with increased
vascularity, and the new vessels can be fragile.
18
Dept of Urology, GRH and KMC, Chennai.
19. 6. Recent vigorous exercise or trauma
7. History of a bleeding disorder or bleeding from multiple sites
due to uncontrolled anticoagulant therapy.
8. Cyclic hematuria in women
9. Medications that might cause nephritis (usually with other
findings, typically with renal insufficiency).
19
Dept of Urology, GRH and KMC, Chennai.
20. • 10. sickle cell trait or disease, which can
lead to papillary necrosis and
hematuria.
• 11. Travel or residence in areas endemic
for Schistosoma hematobium .
20
Dept of Urology, GRH and KMC, Chennai.
21. Work –up
Laboratory Studies :
• Urinalysis
• Phase contrast microscopy
• BUN/serum creatinine: Elevated levels of BUN and creatinine suggest significant
renal disease as the cause of hematuria
• Hematologic and coagulation studies: CBC counts
, Platelet counts
• Urine calcium : calcium excretion of more than 4 mg/kg/d or a urine calcium-
creatinine ratio of more than 0.21 are considered abnormal.
• Serologic testing
• Urine culture
21
Dept of Urology, GRH and KMC, Chennai.
23. Renal Biopsy
A biopsy is not usually performed for isolated
glomerular hematuria (i.e., no proteinuria or renal
insufficiency,) since there is no specific therapy for
these conditions
It is considered if there is evidence of progressive
disease (elevation in the plasma creatinine
concentration, increasing protein excretion) or an
otherwise unexplained rise in blood pressure, even
when the values remain within the normal range
23
Dept of Urology, GRH and KMC, Chennai.
26. 3 container urine test:
Done in MH cases; can provide information on site of
origin of erythrocytes.
• Initial/VB1 – 10 to 15ml of initial urine(ant.Urethra )
• Middle/VB2- 30 to 40 ml of middle portion
• Final – last 5-10 ml of urine ( bladder neck / post. Urethra ).
Presence of equal numbers of RBCs in all 3 containers – indicate
bleeding above bladder neck ( UUT).
3 container test not needed in pts with gross
hematuria.
26
Dept of Urology, GRH and KMC, Chennai.
29. Centrifuged urine
• In hemoglobinuria, the supernatant will be pink. This is
because free hemoglobin in the serum binds to
haptoglobin, which is water insoluble and has a high
molecular weight. This complex remains in the serum,
causing a pink color. Free hemoglobin will appear in
the urine only when all of the haptoglobin-binding sites
have been saturated.
• In myoglobinuria, the myoglobin released from muscle
is of low molecular weight and water soluble. It does
not bind to haptoglobin and is therefore excreted
immediately into the urine. Therefore, in
myoglobinuria the serum remains clear.
29
Dept of Urology, GRH and KMC, Chennai.
30. DIPSTICK EVALUATION
• Short, plastic strips impregnated with different chemical
reagents that react with abnormal substances in blood to
produce colorimetric reaction.
• Abnormal substances that commonly tested with a dipstick
are blood, protein, glucose, ketones, WBCs, urobilinogen and
bilirubin.
• It can detect trace amounts of hemoglobin and myoglobin.
• Can detect 5-10 intact RBC per mm3 of unspun urine
30
Dept of Urology, GRH and KMC, Chennai.
31. • A positive dipstick for blood in the urine indicates either
hematuria, hemoglobinuria, or myoglobinuria.
• Based on peroxidase activity of hemoglobin.
• The reagent strip that detects blood utilizes hydrogen
peroxide, which catalyzes a chemical reaction(oxidation)
between hemoglobin (or myoglobin) and the
chromogen tetramethylbenzidine > colour change.
• Different shades of blue-green are produced according
to the concentration of hemoglobin in the urine
31
Dept of Urology, GRH and KMC, Chennai.
34. • Sensitivity of urinary dipstick in identifying hematuria is 90%, but specificity is low
compared to microscopic examination.
• False positive:
- contaminated urine with menstrual bood,
- high specific gravity urine ( dehydration)
- after exercises/sexual activity.
- Urine pH >9, bacterial peroxidase, oxidizing agents
• False negative:
- formalin. Improper method
34
Dept of Urology, GRH and KMC, Chennai.
35. • Efficacy of hematuria screening using dipstick test in
urological disease is – low.
• Before proceeding to any complicated studies,
dipstick test must be confirmed by microscopic
examination of urinary sediment.
35
Dept of Urology, GRH and KMC, Chennai.
36. Urine microscopy
• acidic and concentrated early morning urine (EMU)
samples are more likely to detect red blood cells (RBC), and
casts; are best preserved in such a medium.
• Analysis should follow rapidly, preferably within 1 hour for
sediment analysis and 2 hours for dipstick testing.
• store at a temperature of 4˚C if a delay is encountered and
analyze as soon as possible
• Quantification tecniques:
1) Sediment count: spinning urine down in centrifuge with
supernant removed. The pellet of cells is then
resuspended in saline and examined under microscope.
2) Chamber count: detects no. of RBCs/ml of urine.
36
Dept of Urology, GRH and KMC, Chennai.
37. • About 10–15 mL is centrifuged at 3,000 rpm for 5 minutes,
with the supernatant subsequently discarded
• 0.01–0.02 mL of the residual sediment is placed directly on
the microscope slide and covered with a coverslip
• Microscopy examination done at both low power (×100)
and high power (×400).
• Low-power magnifi cation is adequate for the identification
of most cells, macrophages, and parasites
• high-power is required to discriminate between circular
and dysmorphic RBC, and to identify crystals, bacteria, and
yeast
• one HPF represents 1/30,000 mL and false negatives, due
to this volume constraint, are therefore inevitable.
37
Dept of Urology, GRH and KMC, Chennai.
38. Phase-contrast microscopy
• to distinguish glomerular from post
glomerular bleeding
38
Dept of Urology, GRH and KMC, Chennai.
42. DIFFERENCE
NON GLOMERULAR GLOMERULAR
COLOUR RED OR PINK RED,SMOKY BROWN
OR COLA COLOUR
CLOTS MAY BE PRESENT ABSENT
PROTEINURIA < 500 MGS/DAY > 500 MGS/DAY
RBC MORPHOLOGY Round / circular DYSMORPHIC
RBC CASTS ABSENT MAY BE PRESENT
42
Dept of Urology, GRH and KMC, Chennai.
43. Glomerular hematuria
• Characterised by
- Dysmorphic RBCs, ( phase contrast microscopy )
- RBC casts,
- Significant Proteinuria.
43
Dept of Urology, GRH and KMC, Chennai.
44. GLOMERULAR CAUSES
• Ig A nephropathy (Berger disease)- MOST COMMON
• Mesangioproliferative GN
• Focal segmental proliferative GN
• Familial nephritis- ALPORTS
• Membranous GN
• Mesangiocapillary GN
• Focal segmental sclerosis
• Systemic lupus erythematous
• Post infectious GN
• others
Renal biopsy is needed for precise diagnosis. 44
Dept of Urology, GRH and KMC, Chennai.
57. Microscopic Hematuria evaluation
• Prevalence of MH in population is 6.5 %.
• One third to two third of patients evaluated for MH have
underlying cause like calculus, infection, inflammation, BPH, MRD,
congenital/ acquired anatomical abnormality and neoplasms.
• Malignancy has been detected in approx 4 % of patients.
• chance of malignancy is higher among the patients with
high levels of MH >25RBC/HPF, GH, or risk factors.
57
Dept of Urology, GRH and KMC, Chennai.
60. AUA guidelines for AMH
• A positive dipstick does not define AMH, and
evaluation should be based solely on findings
from microscopic examination of urinary
sediment and not on a dipstick reading.
• A positive dipstick reading merits microscopic
examination to confirm or refute the diagnosis
of AMH. Expert Opinion
60
Dept of Urology, GRH and KMC, Chennai.
61. • The assessment of the AMH patient should
include a: –careful history
–physical examination
–laboratory examination
to rule out benign causes of AMH such as
infection, menstruation, vigorous exercise,
medical renal disease, viral illness, trauma, or
recent urological procedures. Clinical Principle
61
Dept of Urology, GRH and KMC, Chennai.
62. • Once benign causes have been ruled out, the
presence of AMH should prompt a urologic
evaluation (Evidence Strength Grade C)
• At the initial evaluation, an estimate of renal
function should be obtained (may include
calculated eGRF, creatinine, and BUN) because
intrinsic renal disease may have implications for
renal related risk during the evaluation and
management of patients with AMH. Clinical
Principle
62
Dept of Urology, GRH and KMC, Chennai.
63. • The presence of dysmorphic RBs, proteinuria, cellular
casts, and/or renal insufficiency, or any other clinical
indicator suspicious for renal parenchymal disease
warrants concurrent nephrologic workup but does not
preclude the need for urologic evaluation.
(Evidence Strength Grade C)
• Microhematuria that occurs in patients who are taking
anti-coagulants requires urologic evaluation and
nephrologic evaluation regardless of the type or level
of anticoagulation therapy.
(Evidence Strength Grade C)
63
Dept of Urology, GRH and KMC, Chennai.
64. • For the urologic evaluation of asymptomatic
microhematuria, a cystoscopy should be performed on
all patients aged 35 years and older.
Recommendation(Evidence Strength Grade C)
• In patients younger than age 35 years, cystoscopy may
be performed at the physician's discretion.
Option (Evidence Strength Grade C)
• Regardless of age, A cystoscopy should be performed
on all patients who present with risk factors for urinary
tract malignancies (e.g., irritative voiding symptoms,
current or past tobacco use, chemical exposures)
Clinical Principle
64
Dept of Urology, GRH and KMC, Chennai.
66. • The initial evaluation for AMH should include a
radiologic evaluation:
• Multi-phasic computed tomography (CT)
• Urography (without and with intravenous (IV)
contrast)
including sufficient phases to evaluate the renal
parenchyma to rule out a renal mass and an excretory
phase to evaluate the urothelium of the upper tracts, is
the imaging procedure of choice because it has the
highest sensitivity and specificity for imaging the upper
tracts.
Recommendation (Evidence Strength Grade C)
66
Dept of Urology, GRH and KMC, Chennai.
67. • For patients with relative or absolute
contraindications that preclude use of
multiphasic CT (such as renal insufficiency,
contrast allergy, pregnancy): magnetic
resonance urography (MRU) (without/with IV
contrast) is an acceptable alternative imaging
approach.
Option (Evidence Strength Grade C)
67
Dept of Urology, GRH and KMC, Chennai.
68. • For patients with relative or absolute
contraindications that preclude use of
multiphase CT (such as renal insufficiency,
contrast allergy, pregnancy) where collecting
system detail is deemed imperative: (MRI)
with retrograde pyelograms (RPGs) provides
alternative evaluation of the entire upper
tracts
Expert Opinion
68
Dept of Urology, GRH and KMC, Chennai.
69. • For patients with relative or absolute
contraindications that preclude use of multiphase
CT (such as renal insufficiency, contrast allergy)
and MRI (presence of metal in the body) where
collecting system detail is deemed imperative:
combining non-contrast CT or renal ultrasound
(US) with retrograde pyelograms (RPGs) provides
alternative evaluation of the entire upper tracts.
Expert Opinion
69
Dept of Urology, GRH and KMC, Chennai.
70. • The use of urine cytology and urine markers
(NMP22, BTA-stat, and UroVysion FISH): is NOT
recommended as a part of the routine evaluation
of the AMH patient.
Recommendation (Evidence Strength Grade C)
• In patients with persistent microhematuria
following a negative work up or those with other
risk factors for carcinoma in situ (e.g., irritative
voiding symptoms, current or past tobacco use,
chemical exposures): cytology may be useful.
Option (Evidence Strength Grade C)
70
Dept of Urology, GRH and KMC, Chennai.
71. • Blue light cystoscopy : should not be used in the
evaluation of patients with SMH.
(Evidence Strength Grade C)
• If a patient with a history of persistent AMH has 2
consecutive negative annual urinalyses (one per
year for two years from the time of initial
evaluation or beyond): then No further urinalyses
for the purpose of evaluation of AMH are
necessary.
Expert Opinion
71
Dept of Urology, GRH and KMC, Chennai.
72. • For persistent AMH after negative urologic
work up: Yearly urinalyses should be
conducted.
Recommendation (Evidence Strength Grade
C)
• For persistent or recurrent AMH after initial
negative urologic work-up: Repeat evaluation
within 3-5 years should be considered.
Expert Opinion
72
Dept of Urology, GRH and KMC, Chennai.
73. Gross hematuria evaluation
• 50 % have demonstrable cause, with 25% found to
have urological malignancy.
• All patients must be evaluated with cystoscopy,
cytology and imaging CTU.
73
Dept of Urology, GRH and KMC, Chennai.
74. Common causes of Gross hematuria:
• Trauma
• Tumor
• Urolithiasis/hypercalciuria
• Urinary tract infection
• Meatal stenosis
• Perineal irritation
• Coagulopathy
74
Dept of Urology, GRH and KMC, Chennai.
75. Causes of Hematuria in the Newborn:
• Renal vein thrombosis (Asphyxia, dehydration, shock)
• Renal artery thrombosis
• Autosomal recessive polycystic kidney disease
• Obstructive uropathy
• Urinary tract infection
• Bleeding and clotting disorders
• Trauma, bladder catheterization
• Cortical necrosis (Hypoxic/ischemic perinatal insult)
• Nephrocalcinosis (Frusemide in premature)
75
Dept of Urology, GRH and KMC, Chennai.
76. Causes of INTRACTABLE
HEMATURIA
• Radiation cystitis
• Carcinoma bladder
• Cyclophosphamide induced cystitis
• Severe infection
Most pts will be elderly & not fit for cystectomy
76
Dept of Urology, GRH and KMC, Chennai.
78. INTRAVESICAL ALUM IRRIGATION
• It was first introduced by Floyd Csir in 1982.
• 1% alum solution (aluminum ammonium sulphate or
aluminum ammonium phosphate )was given intravesically
through 3 way Foley catheter.
• Alum works by astringent action of protein precipitation on
the cell surface & superficial interstial space.
• It leads to decreased permeability ,vasoconstriction
&reduction of edema.
• Aluminum toxicity may occur in renal failure patients & who
have large tumour surface area.
78
Dept of Urology, GRH and KMC, Chennai.
79. INTRAVESICAL HELMSTEIN’S HYDROSTATIC
PRESSURE
• It works by simple tamponade mechanism
• By increasing the Intravesical pressure , the blood flow
to bladder was decreased & haematuria was stopped.
• The tip of the Foley catheter was cut & it is attached to
the balloon or condom at the distal end, so that the
Foley balloon could be inflated within the balloon.
• Under epidural aneasthesia the balloon was introduced
into the bladder &filled with sterile water above 10 to
25 cm of water of diastolic BP.
• It is kept for 6 hours & removed.
• Serious complication is bladder rupture & patient will
have severe abdominal pain
79
Dept of Urology, GRH and KMC, Chennai.
80. INTRAVESICAL FORMALIN THERAPY
• Formalin precipitates the cellular proteins of bladder
mucosa & cause edema & tissue necrosis.
• Under spinal aneathesia the bladder is filled with 1 to
2% of formalin & contact time is 15 minutes.
• The success rate is 80 %.
• Complications are small contracted bladder,ureteric
stricture,vesicovaginal fistula,toxic effect on
myocardium & bladder rupture.
• Due to potential complications ,formalin is used very
rarely.
80
Dept of Urology, GRH and KMC, Chennai.
82. EMBOLIZATION
• Therpuetic embolization was described by
Hald in 1984.
• The internal iliac artey was catheterised by
puncturing the femoral or axillary artery
• The internal iliac artery or its anterior division
can be embolized with gel foam.
• The commonest complication is superior
gluteal pain & rarely gangrene of the bladder .
• The success rate is 90 %.
82
Dept of Urology, GRH and KMC, Chennai.
83. HYPERBARIC OXYGEN THERAPY FOR RADIATION
CYSTITIS
• RT causes progressive obliterative endarteritis of
small blood vessels & cause tissue hypoxia.
• Hyperbaric oxygen therapy causes
neovascularisation of bladder wall& increase the
oxygen tension in the bladder.
• 20 session of 100% hyperbaric oxygen inhalation
in .3mPa in a hyperbaric chamber .(each session
90 minutes).
• Decompression sickness may occur rarely.
• Success rate is 75 %.
83
Dept of Urology, GRH and KMC, Chennai.
84. Other therapies
Oral sodium pentosan polysulphate: is useful in
radiation cystitis.
• Dose is 100 mgm three times daily for 3 to 4
weeks .
• It will coat the lining of bladder & increase the
mucosa urine interface.
Intravesical PG are useful in cyclophosphamide
induced cystitis.
84
Dept of Urology, GRH and KMC, Chennai.
88. Prostate related hematuria
• BPH represents most common cause of
prostate related GH. Others are
prostatitis, cancer.
88
Dept of Urology, GRH and KMC, Chennai.
90. Urethral bleeding / Urethrorrhagia
• Bleeding from urethra at a point distal to bladder neck,
occuring separate from micturition.
• Retrograde urethrogram and cystourethroscopy are
mainstays for diagnosis in pts with suspected urethral
bleeding.
90
Dept of Urology, GRH and KMC, Chennai.
92. Upper urinary tract bleeding
• Cystoscopy at time of bleeding may allow lateralization of
source of hematuria.
• Direct ureteropyeloscopy is recommended as a
diagnostic and potential therapeutic modality in UUT
bleeding.
• Angiography and selective angioembolization is a primary
diagnostic and therapautic option for suspected vascular
conditions causing hematuria.( AVM, ruptured
aneurysms, iliac-ureteral fistulas,nutcracker syndromes.)
92
Dept of Urology, GRH and KMC, Chennai.
93. TRAUMA RELATED HEMATURIA
Degree of hematuria and severity of renal injury are not
corelated.
Criteria for imaging in renal trauma:
all penetrating and decelaration trauma
all blunt trauma with GH
all blunt trauma with MH with shock
all pediatric pts with MH.
93
Dept of Urology, GRH and KMC, Chennai.
94. • Patients with MH without shock can be observed
clinically without imaging studies.
• CECT is gold standard imaging in renal trauma.
94
Dept of Urology, GRH and KMC, Chennai.
97. FOLLOW UP:
depends upon age and degree of hematuria
1. Adults:
-One episode of gross hematuria and a- ve evaluation
do not need follow up , unless recurred
-Microscopic hematuria: - ve evaluation,
routine follow up with urine analysis ,cytology ,
blood pressure measurements for 3 yrs at 6,12,24
and 36 months
Most recent studies less aggressive or even no follow up, unless
recurrence
2.Children:
-Gross or microscopic hematuria ,-ve evaluation ,
annual re-evaluation with urine analysis
for proteinuria &blood pressure measurement
97
Dept of Urology, GRH and KMC, Chennai.
98. CONCLUSION :
The initial evaluation ,investigation &follow up depends upon
whether pt is a child or an adult
*Main concern in children is to distinguish between glomerular
course
*In adult to differentiate between benign & malignant course.
*In children imaging studies should begin with renal &
bladder USG
*In adult urine culture ,CT IVP, cystoscopy and urine cytology
Follow up:
*In children
After initial –ve evaluation follow up should be routine
*In adults not necessary
98
Dept of Urology, GRH and KMC, Chennai.