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Atallah A. Shaaban<br />
41<br />
Hematuria<br />
<strong>Basic</strong> <strong>Urology</strong>: History Taking<br />
Definition: Blood in urine.<br />
Hematuria can be classified in different ways:<br />
A) Intensity:<br />
1- Microscopic: The presence of >5 RBCs / hpf.<br />
2- Macroscopic or Gross: Urine is red. This is a "red sign" for the<br />
patient to ask for medical advice.<br />
B) Origin:<br />
1- Systemic disease.<br />
2- Urinary tract pathology.<br />
C) Relation to micturition:<br />
1- Total hematuria is present all over the voided urine. Underlying<br />
pathology may be in kidney, ureter, bladder or prostate or<br />
systemic. Bleeding from kidney is associated with cylindrical<br />
worm-like clots. Hematuria from bladder and prostate is<br />
associated with big irregular or discoid clots.<br />
2- Terminal hematuria at the end of micturition is of vesical origin<br />
e.g. active bilharzial cystitis. It is usually due to bladder neck or<br />
prostatic inflammation.<br />
3- Initial hematuria at the beginning of micturition indicates urethral<br />
pathology.<br />
D) Associated symptoms:<br />
Painless hematuria: No other urinary symptoms: All cases should<br />
be investigated for urologic malignancy. Bladder cancer is the<br />
most common and should be excluded.<br />
Hematuria associated with other symptoms:<br />
Simple cystitis: frequency, burning, urgency and terminal<br />
hematuria.<br />
Malignant cystitis: severe frequency, pain, urge incontinence,<br />
total hematuria with clots or necroturia.
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