Hematuria

Barocas, Daniel A., et al. "Microhematuria: AUA/SUFU Guideline." The Journal of urology 204.4 (2020): 778-786.

Hematuria by the Numbers

Hematuria Risk Factors

Lee, Joo Yong, et al. "Hematuria grading scale: a new tool for gross hematuria." Urology 82.2 (2013): 284-289.

Non-Bladder Causes of Hematuria and Managment Considerations

BPH

Prostate Cancer

Urethrorrhagia

Upper tract causes

Random causes of hematuria

Hemorrhagic Cystitis

Common Causes

Medical Management

Drug Mechanism Dosing Considerations Needs OR/Anesthesia?
Alum
Aluminum ammonium sulfate
Aluminum potassium sulfate
Protein precipitation
Vasoconstriction
1% solution (10g/L)
run at 200-300mL/hr
Success: 45-100%
Aluminum toxicity
No
Silver Nitrate Chemical coagulation 0.5-1% instilled for 10-20 minutes Check cystogram
(can cause obstruction if VUR)
No
Amicar
Aminocaproic acid
Inhibits fibrinolysis 200g/L
Give for 24hr after hematuria resolves
Success: up to 92%
Do not give if bladder clots present (causes clots to harden)
No
Formalin Cellular protein precipitation 1-4%
300mL or up to bladder capacity
10-15 minutes
Success: 80-90%
Bladder fibrosis
Ureteral strictures if VUR
Yes

Non-Medical Management

Treatment Tips
Hyperbaric Oxygen 100% O2 at 2-3 atm, 90 minutes, 30-40 sessions
Success: 80-90% response rate, but 5yr success only 27%
Side effects: claustrophobia (20%), otalgia (17%), seizures (rare)
Nephrostomy tubes Avoids bladder exposure to urokinase, allowing clots to form
Can be performed with ureteral coiling
Internal iliac artery embolization Can be performed unilaterally/bilaterally
Posterior occlusion results in significant gluteal pain
Success: up to 90%
Cystectomy + Urinary Diversion Complications in up to 80% if bladder not removed
High risk of complications

Things that look like hematuria...but aren't hematuria

References