Thursday 22 April 2010

haematuria

1. A 53-year-old man attends as a new patient to your practice. He has no previous past medical history and is not taking any regular medication. As part of his new patient check, the following results are obtained:

Urinalysis Blood++

Mid-stream urine (MSU) Negative

Blood pressure 112/68 mmHg

Urea and electrolytes Normal

Which ONE of the following options is the most appropriate INITIAL management for this patient? Select ONE option only.


A. Check prostate-specific antigen (PSA)
B. Re-check urinalysis in 2 weeks
C. Referral for renal ultrasound scan
D. Routine referral to renal physician
E. Urgent referral to urological surgeon

answer: E

Regarding the management of suspected urological cancer:

•Male or female adult patients of any age who present with painless macroscopic haematuria should be referred urgently.
•In male or female patients with symptoms suggestive of a urinary infection who also present with macroscopic haematuria, investigations should be undertaken to diagnose and treat the infection before consideration of referral. If infection is not confirmed the patient should be referred urgently.
•In all adult patients 40 years of age and older who present with recurrent or persistent urinary tract infection associated with haematuria, an urgent referral should be made.
•In patients under 50 years of age with microscopic haematuria, the urine should be tested for proteinuria and serum creatinine levels measured. Those with proteinuria or raised serum creatinine should be referred to a renal physician. If there is no proteinuria and serum creatinine is normal, a non-urgent referral to a urologist should be made.
•In patients 50 years of age and older who are found to have unexplained microscopic haematuria, an urgent referral should be made.
Any patient with an abdominal mass identified clinically or on imaging that is thought to be arising from the urinary tract should be referred urgently.




Urgent referral to urological surgeon