Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Gross haematuria
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Introduction
If a patient is experiencing frank haematuria with the passage of clots, the most immediate risk is of clot retention, whichmay be difficult to resolve. It is extremely rare for haematuria to present to such a degree that it becomes acutely life threatening from exsanguination, although those on anticoagulant medication are at more risk. Gross haematuria is significant in the setting of genitourinary trauma.
Definition and classification
There is no absolute definition for massive haematuria. Haematuria is divided into microscopic and macroscopic (gross/frank) and then further divided into painless or painful. Initial painless macroscopic haematuria may become painful with the passage of clots or impending clot retention.
History
A good history and examination will indicate the likely source of haematuria. Initial simple classifications, as above, will include/exclude multiple causes. It is always important to take a full urological history including:
▪ Previous urological procedures
▪ History of UTIs/STDs
▪ Lower urinary tract symptoms (LUTS)
▪ Risk factors for urinary tract malignancies (smoking/occupational risks/family history)
▪ Preceding trauma.
A thorough past medical and drug history will also highlight diagnosis and treatments associated with haematuria, such as anticoagulant/antiplatelet agents.
Examination
In the presence of extreme haematuria, the patient should be resuscitated with regards to their airway, breathing and circulation. This may well be in the setting of advanced trauma life support (ATLS) if trauma has been a precipitating cause. Once intravenousaccess and fluid resuscitation have been initiated, examination can be directed towards identifying a cause for haematuria. A full abdominal system examination, including external genitalia in both men and women and digital rectal examination (DRE) in men is thus performed.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 287 - 290Publisher: Cambridge University PressPrint publication year: 2009