Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 23-02: Hematuria + Key Features Download Section PDF Listen +++ ++ Both gross and microscopic hematuria require evaluation The upper urinary tract should be imaged Cystoscopy should be performed if there is hematuria in the absence of an identifiable benign cause Urinary cytology can be obtained after initial negative imaging and cystoscopic evaluation If work-up is negative, the cystoscopy and upper tract imaging should be repeated after 1 year + Clinical Findings Download Section PDF Listen +++ ++ If gross hematuria occurs, a description of the timing (initial, terminal, total) may provide a clue to the localization of disease Associated symptoms to inquire about Renal colic Irritative voiding symptoms Constitutional symptoms Signs of systemic disease Fever Rash Lymphadenopathy Abdominal or pelvic masses Signs of medical kidney disease Hypertension Volume overload Urologic evaluation may demonstrate Enlarged prostate Flank mass Urethral disease + Diagnosis Download Section PDF Listen +++ ++ Urinalysis and urine culture Microhematuria is defined as 3 or more red blood cells per high power field on a microscopic evaluation of the urine A positive dipstick reading for heme merits microscopic examination to confirm or refute the diagnosis of hematuria but is not enough to warrant workup on its own If urinalysis and culture is suggestive of a urinary tract infection, follow-up urinalysis after treatment of the infection is important to ensure resolution of the hematuria An estimate of kidney function should be obtained since renal insufficiency may influence the methods of further evaluation (eg, ability obtain contrast imaging) and management of patients with hematuria Urine cytology and other urinary-based markers are not routinely recommended in the evaluation of asymptomatic microscopic hematuria CT-intravenous pyelogram (CT-IVP) Upper tract should be imaged with no contrast, with contrast, and with excretory delayed imaging to identify neoplasms of the kidney or ureter as well as benign conditions such as Urolithiasis Obstructive uropathy Papillary necrosis Medullary sponge kidney Polycystic kidney disease A magnetic resonance urogram without and with contrast can be performed for patients with relative or absolute contraindications that preclude a CT-IVP, such as Kidney disease Intravenous contrast allergy Pregnancy Ultrasonographic evaluation of the urinary tract for hematuria Role is unclear Although it may provide adequate information about the kidney, its sensitivity in detecting ureteral disease is lower Cystoscopy Is necessary for Bladder or urethral neoplasm Benign prostatic hyperplasia Radiation or chemical cystitis Indications Gross hematuria Presence of asymptomatic microscopic hematuria in patients > 35 years old Best performed while patient is actively bleeding to allow better localization + Treatment Download Section PDF Listen +++ ++ Should be directed to the underlying cause of the hematuria