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Hematuria and Transitional Cell Carcinoma

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Hematuria and Transitional Cell Carcinoma

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    1. Hematuria and Transitional Cell Carcinoma DR. omaya bani-hani urologist Done by : sohaib omari Hossam omari

    3. Definitions The recommended definition of hematuria is the presence three or more red blood cells per high-power field on microscopic evaluation of urinary sediment from two of three properly collected urinalysis specimens Soo This is detected by urinalysis .. dipstick and/or microscopy. DDx diagnosis for red urine : beetroot, Drugs (Rifampicin, dindevan, pynidium, furadantin),hemoglobinuria , distinguished from hematuria by absence of RBCs on U/A The urinalysis also looks at different factors that may point out certain crucial points eg, ph , protein , glucose ,spicific gravity ..

    4. dipstick Should be used in fresh urine spacemen

    5. Urological vs. Medical causes Presence of casts, dismorphic RBCs ,fixed specific gravity, proteinuria, Glucosuria , renal insufficiency may point to glomerular origin of the bleeding.

    6. Significance of hematuria The most serious symptom in Urology Hematuria is a sign of malignancy until proven otherwise. Microscopic hematuria is more dangerous because; time can elapse before diagnosis and malignancy is more likely to present as microscopic hematuria . Severity of the condition is not always proportionate to the severity of hematuria.

    7. Classifying hematuria According to the act of void: -Initial. -Terminal. -Total. painful vs. painlees Mode of discovery: Gross vs. microscopic

    8. Initial questions Is the hematuria gross or microscopic? At what time during urination does the hematuria occur (beginning or end of stream or during entire stream)? Is the hematuria associated with pain? Is the patient passing clots? If the patient is passing clots, do the clots have a specific shape? Has a kidney stone been passed (noise in toilet bowl)?

    9. Initial hematuria usually arises from the urethra; it occurs least commonly and is usually secondary to inflammation. Terminal hematuria occurs at the end of micturition and is usually secondary to inflammation in the area of the bladder neck or prostatic urethra

    10. Total hematuria is most common and indicates that the bleeding is most likely coming from the bladder or upper urinary tracts.

    11. is usually not painful unless it is associated with inflammation or obstruction. pain in association with hematuria usually results from upper urinary tract in the LUT the associated symptoms are usually irritative.

    12. Presence of Clots The presence of clots usually indicates a more significant degree of hematuria, and, accordingly, the probability of identifying significant urologic pathology increases

    13. Work up UA for confirmation,. Ultra sound Cystoscopy, Cystoscopy and Cystoscopy. Urine Cytology. Retrograde pyelography. Upper tract imaging (CT, IVU,, Angio)

    14. cyctoscopy In a patient who presents with gross hematuria, cystoscopy should be performed as soon as possible, because frequently the source of bleeding can be readily identified. Cystoscopy will determine whether the hematuria is coming from the urethra, bladder, or upper urinary tract .

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