From the Guidelines
Frank hematuria requires a thorough workup, including a complete history, physical examination, urinalysis, and urine culture, as well as imaging studies such as CT urogram and cystoscopy, to identify its cause and rule out serious conditions like malignancy, stones, infection, or glomerular disease. The initial evaluation should also include laboratory tests like complete blood count, coagulation studies, renal function tests (BUN, creatinine), and serum electrolytes 1. According to the American College of Radiology, gross hematuria has a high association with malignancy, and all patients with gross hematuria should have a full urologic workup 1.
Key Components of the Workup
- Complete history and physical examination to identify risk factors for urinary tract cancer, such as smoking history, chemical exposure, or prior pelvic radiation 1
- Urinalysis and urine culture to rule out infection or other benign causes of hematuria 1
- Imaging studies, starting with a CT urogram, to provide detailed images of the entire urinary tract 1
- Cystoscopy to directly visualize the bladder and urethra, particularly in patients over 35 years or those with risk factors for bladder cancer 1
Special Considerations
- Patients with compromised renal function may require alternative imaging like ultrasound or MRI urogram instead of CT with contrast 1
- The urgency of workup depends on associated symptoms, with severe pain, clots causing obstruction, or significant anemia requiring immediate attention 1
- Referral to a urologist is warranted if initial evaluation is negative but hematuria persists 1
Importance of Prompt Diagnosis
Prompt diagnosis and treatment of underlying conditions can significantly improve outcomes, particularly for urological cancers where early detection affects prognosis 1. Therefore, it is essential to prioritize a thorough workup for patients with frank hematuria to ensure timely identification and management of any underlying serious conditions.
From the Research
Frank Haematuria Work Up
- Frank haematuria is defined as the presence of blood in the urine, either on voiding or in a catheterized specimen 2
- The causes of frank haematuria include a wide spectrum of conditions, such as calculus, trauma, tumors, vascular, and miscellaneous causes 2
- Diagnostic techniques for frank haematuria include:
- Plain X-rays of the kidney, ureter, and bladder
- Ultrasound
- Intravenous urography
- Computed tomography (CT)
- Magnetic resonance imaging
- Retrograde ureterography and pyelography (RGP)
- Cystoscopy
- Ureteroscopy 2
- CT urography is a useful diagnostic tool for evaluating frank haematuria, and can be used alone for this task 2
- The CT urography protocol includes:
- Unenhanced scan to evaluate basic parameters such as size, shape, position, and outline of the kidneys and calculus disease
- Nephrographic phase to visualize renal parenchymal diseases, including masses, and other abdominal organs
- Excretory phase to detect urothelial diseases, including the kidneys, ureters, and bladder 2