Talking about surgical hematuria
Hematuria is a term used in Western medicine, while in Chinese medicine it is called blood in urine and is clinically characterized by the presence of blood mixed in the urine. What is commonly referred to as blood in urine is generally referred to as hematuria of the naked eye. Western medicine refers to hematuria as the presence of red blood cells mixed in the urine. In clinical work, a microscopic count of more than three red blood cells per high magnification field of view is considered to be of some significance. The color of hematuria is mainly affected by the amount of blood mixed into the urine, when there is a lot of blood, the urine is visible to the naked eye as blood-colored, and the color of hematuria varies from light pink to dark brown soy sauce color due to the difference in the amount of blood and the time of bleeding old and new, and blood clots can be formed in the urine when there is a lot of bleeding.
Is red urine always hematuria?
Normal urine is pale yellow in color because it contains urine pigment. The color change of urine is related to the amount of water consumed that affects the concentration. The consumption of some foods (e.g. beets, blackberries), drugs (e.g. rifampin, phenolphthalein) and chronic lead and mercury poisoning can also cause abnormal urine color. In addition hemoglobinuria due to hemolysis from various causes and myoglobinuria in patients with crush syndrome from trauma such as post-earthquake crush injuries can also turn the urine red. However, these are not what we usually call hematuria in clinical practice. Clinicians can easily identify true hematuria by taking a brief history with a centrifugal urine sediment test for red blood cell counts. In female patients, even if the tests suggest true hematuria, experienced physicians will often ask about menstruation and examine the female genital tract to avoid misclassification as hematuria due to menstrual blood or other causes of genital tract bleeding that contaminate the urine.
How to identify the factors causing hematuria as a medical or surgical condition
Hematuria generally reflects the presence of kidney or urinary tract disease. A urinalysis for hematuria of renal origin of medical origin is often accompanied by tubular urine or/and proteinuria, but it can be distinguished by the fact that even in severe surgical disease hematuria of urinary tract origin does not result in a urinary protein concentration of 100-300 mg/dl. In addition, morphological examination of centrifuged urine sediment for red blood cells will help to determine whether the hematuria is of medical or surgical origin. The internal origin of erythrocytes from glomerular disease is usually more than 80% abnormal morphology, which is the result of cell fission and deformation triggered by compression of the glomerular basement membrane and the difference in osmotic pressure gradient in the renal tubules. The so-called surgical causes, i.e., erythrocytes originating from the tubulointerstitial and urinary tracts, are round and homogeneous in morphology.
Because the diseases that cause medical and surgical hematuria are different, the treatment must not be the same, so the first step in the treatment of hematuria is to go to the hospital, and only through the examination can the doctors distinguish between medical and surgical causes, and then they can take targeted treatment measures.
Characteristics of surgical hematuria
Urologists who encounter patients with hematuria usually ask the following questions to initially determine the site, nature and extent of hematuria.
1.Is hematuria seen by the naked eye or just under the microscope of urine examination: It is important to know that 1 ml of blood mixed in 1000 ml of urine can show hematuria recognizable to the naked eye, so hematuria needs to be taken seriously, but it is not necessary to panic when seeing hematuria and just rush the doctor to stop the bleeding quickly while ignoring the examination to clarify the cause. It should be emphasized that the color shade of hematuria is not completely consistent with the severity of the disease.
2. Whether the time of appearance of hematuria is at the beginning or the end of urination or throughout the entire urination process: The time of appearance of hematuria during urination can often indicate the general source of hematuria. A urination process that only shows blood at the beginning of urination and then gradually turns clear often indicates a lesion in the urethra or bladder outlet area. Hematuria that occurs only at the end of urination, also called terminal hematuria, suggests that the lesion may be in the bladder triangle, bladder neck, or prostate urethra. If the hematuria is present throughout the whole process of one urination, it suggests that the chance of hematuria originating from the kidney, ureter and bladder is the greatest, and further endoscopy may be needed to clarify.
3. Whether hematuria is accompanied by pain: When the urinary tract is inflamed or obstructed, hematuria can be accompanied by painful symptoms. If it is cystitis, it can be manifested as hematuria accompanied by painful urination, frequent urination and urgent urination. In case of acute obstruction of the urinary tract caused by stones or other reasons, blood in urine is often accompanied by pain in the lower back and abdomen on the affected side.
4, whether hematuria is accompanied by blood clots: the presence of blood clots indicates a large amount of local bleeding from the lesion. If the clot is like a worm-like blood strip, it often indicates that the bleeding site is in the kidney and the amount of bleeding is large.
Whether the hematuria is painless or not: This is what urologists attach most importance to, and it is often a characteristic of urological tumor, and this kind of hematuria is deceptive to patients, and it is often intermittent and stops when it occurs.
6, whether hematuria is accompanied by urinary frequency, urinary urgency, urinary pain and other urinary tract irritation symptoms: often suggests that it may be urinary tract specific or non-specific inflammation, and requires further examination.
7, whether suffering from systemic diseases or application of anticoagulant drugs: Hematuria can also occur in patients with hemophilia, aplastic anemia, thrombocytopenic purpura or in patients who are applying anticoagulant drugs, but the bleeding in such patients is often not limited to blood in the urine, but will also manifest itself in other areas such as the mouth, nose, skin and other areas.
Tests commonly used by urologists for hematuria
1.The presence or absence of hematuria is clarified by routine examination of urine sediment, and further morphological examination of red blood cells distinguishes surgical hematuria or medical hematuria.
2. If medical hematuria is considered, further examination or even renal aspiration biopsy may be required to clarify the pathological diagnosis in order to guide the development of a treatment plan.
3.If surgical hematuria is considered, for patients with abnormalities in both kidneys, ureter and bladder not detected by ultrasound, further urological imaging, CT or MRI may be required, which can simultaneously understand renal function and renal vascularity.
4. If the cause of bleeding is unknown and the urinary exfoliation cytology is abnormal, further cystourethroscopy must be performed as long as the patient’s physical condition allows, and if the hematuria is considered to originate from the ureter or kidney, ureteroscopy will be performed in conjunction. These endoscopies are very intuitive and can not only directly detect the site of bleeding or even directly deal with smaller lesions.
A few notes
1, not necessarily hematuria if the urine becomes red, you should ask a professional doctor to check and identify.
2, not only the kidney and urinary tract problems will appear hematuria, must not take the initiative, should ask a professional doctor to clarify.
3.If hematuria occurs, especially painless hematuria, do not ignore it because it disappears on its own without treatment, but pay attention to it and go to the urology department of a regular hospital and ask the doctor to help exclude urinary tract tumors.
4. For some hematuria that cannot be diagnosed after systematic examination, we must also actively treat the symptoms and at the same time, we must closely observe the follow-up.