From the Guidelines
Frank hematuria following catheterization is most likely due to trauma from the catheter insertion process, and a thorough workup including cystoscopy is essential to rule out other potential causes. The initial evaluation should include a detailed history and physical examination, focusing on catheterization details, medication use, and urinary symptoms. Laboratory tests such as urinalysis with microscopy, urine culture, complete blood count, coagulation studies, and renal function tests should be performed 1. Imaging studies like renal ultrasound, CT urogram, or cystoscopy may be necessary depending on clinical suspicion. According to the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction, patients with concomitant hematuria, recurrent urinary tract infections, or suspected anatomic anomaly should undergo cystoscopy 1. Additionally, any patient with painless gross hematuria requires upper tract imaging and a cystoscopy 1. Management typically involves removing or replacing the catheter if appropriate, treating any underlying infection with antibiotics, ensuring adequate hydration, and monitoring urine output and color. If bleeding is severe or persistent, urological consultation is warranted. Preventive measures for future catheterizations include using proper technique, appropriate catheter size, adequate lubrication, and minimizing catheter duration. It is also essential to educate patients on the signs and symptoms that would warrant additional assessment, including new or worsening symptoms, urinary tract infections, or difficulties catheterizing 1. Patients with low-risk NLUTD who present with new onset signs and symptoms or complications should be re-evaluated and repeat risk stratification 1. Key points to consider in the workup and management of frank hematuria following catheterization include:
- Thorough history and physical examination
- Laboratory tests such as urinalysis, urine culture, and renal function tests
- Imaging studies like renal ultrasound, CT urogram, or cystoscopy
- Cystoscopy to rule out anatomic anomalies or other potential causes
- Management of underlying infection or other conditions
- Preventive measures for future catheterizations
- Patient education on signs and symptoms that warrant additional assessment.
From the Research
Causes of Frank Haematuria
- Upper urothelial cell carcinomas (UCC) are a possible cause of frank haematuria, with an incidence of 1.9% in patients with hematuria who undergo CT urography after a negative cystoscopy 2
- Other potential causes of hematuria include benign processes and life-threatening conditions, such as urologic malignancy, which is more common in the elderly 3
Workup for Frank Haematuria
- A focused history and physical, including laboratory studies and diagnostic imaging, is essential in evaluating patients with hematuria 3
- Three-phase CT urography (CTU) is the gold standard for evaluating the upper urinary tract in patients with hematuria, with a sensitivity of 100% and specificity of 99% for detecting upper UCCs 2
- The nephrographic phase of CTU is sufficient for detecting upper UCCs, as all cases were visible on this phase in one study 2
- Patients with hematuria should be considered for close outpatient follow-up, especially if they are elderly, as hematuria can signal the presence of urologic malignancy 3