Evaluation of asymptomatic, atraumatic hematuria in children and adults

[Urinary bladder tamponade-an urological emergency]

BACKGROUND

Urinary bladder tamponade is a urological emergency that is part of the clinical routine of every urologist and requires immediate and adequate diagnosis and therapy.

OBJECTIVES

Presentation of the clinical picture of urinary bladder tamponade including etiology, diagnostics, and therapy as well as formulation of recommendations for action for clinical routine.

MATERIALS AND METHODS

Structured presentation of the diagnosis and therapy of urinary bladder tamponade with practical recommendations for action based on a current literature search and a clinical case study.

RESULTS

Urinary bladder tamponade is a usually painful filling of the urinary bladder with blood clots as part of gross hematuria. The central pillars of diagnostics are anamnesis, targeted physical examination, and sonography. Therapy involves the rapid insertion of a flushing catheter with manual evacuation of the tamponade. A flushing catheter with at least 20 French should be used here.

CONCLUSION

Timely diagnosis and prompt treatment are crucial. This usually includes transurethral catheter insertion with manual evacuation. If the tamponade is unsuccessfully removed, further measures such as endoscopic evacuation or, as a last resort, sectio alta or radical cystectomy are available.

Diagnostic yield of repeat evaluation for asymptomatic microscopic hematuria after negative initial workup

PURPOSE

The American Urological Association guideline for asymptomatic microhematuria recommends in patients with a negative initial workup, repeat workup should be considered for those with persistent/recurrent microhematuria. However, there is little data on the yield of repeat evaluation. Our hypothesis was that repeat workup yields a low detection rate of urologic malignancy.

MATERIALS AND METHODS

We retrospectively reviewed all patients at our institution who underwent microhematuria workup with cystoscopy and upper tract imaging from May 2010 to June 2016. Microhematuria was defined as ≥3 RBCs/HPF on a properly collected specimen in the absence of a benign cause. Demographics, age, smoking history, history of radiation, and findings on repeat cystoscopy and imaging were collected. Our primary endpoint was a new diagnosis of urologic malignancy.

RESULTS

Our initial cohort included 1,332 patients, of whom 21 were diagnosed with urothelial carcinoma and 7 with suspicious renal masses on initial workup. A total of 637 patients with negative initial workup had persistent/recurrent microhematuria. Repeat cystoscopy was performed in 161 (25%) patients at a median of 39 months, and repeat upper tract imaging was performed in 317 (50%) patients at a median of 39 months. Overall, repeat cystoscopy revealed new bladder cancer in 2 (1.2%) patients and repeat imaging revealed new suspicious renal mass in 4 (1.3%) patients.

CONCLUSIONS

We observed a low number of newly diagnosed malignancies among patients with persistent/recurrent asymptomatic microhematuria who had a prior negative workup. Additional research is required to determine the utility of a repeat AMH workup.

Characteristics and significant predictors of detecting underlying diseases in adults with asymptomatic microscopic hematuria: a large case series of a Korean population

OBJECTIVE

To provide detailed characteristics of asymptomatic microscopic hematuria, as well as to identify the significant predictors of detecting underlying diseases of asymptomatic microscopic hematuria, by evaluating a large Korean population.

METHODS

We obtained data from healthy adults over the age of 20 years who underwent the health-screening program from 2005 to 2010 at Seoul National University Bundang Hospital, resulting in 56,632 participants included in the analysis. Patients who had microscopic hematuria (five red blood cells/high-power field) were referred to a urological outpatient clinic for further urological evaluation. An underlying disease of asymptomatic microscopic hematuria was predefined as a urinary stone, renal mass, urothelial cancer or other relevant lesions.

RESULTS

At the initial urinalysis, 6.2% (3517/56,632) were diagnosed with asymptomatic microscopic hematuria. Of these, 1619 participants underwent repeat urinalysis within 1 year after screening, and 911 (56.3%) participants were detected with microscopic hematuria again. We identified 131 lesions (3.7%) as underlying diseases for asymptomatic microscopic hematuria, with urinary stone as the most common cause. Just six lesions were malignant: three renal cell carcinomas and three bladder cancers. Male sex and diabetes mellitus were significant predictors for detection of underlying diseases of asymptomatic microscopic hematuria.

CONCLUSIONS

Herein we report the largest screening case series of asymptomatic microscopic hematuria including approximately 60,000 asymptomatic participants studied at a single institution. These findings provide clinical practice information for the management of asymptomatic microscopic hematuria in adults.