Macroscopic Hematuria—A Leading Urological Problem in Patients on Anticoagulant Therapy: Is the Common Diagnostic Standard Still Advisable?

Abstract

All urological standards of care are based on the past definition of the clinical importance of macroscopic hematuria. The aim of the study was to assess the phenomenon of iatrogenic hematuria in current clinical practice and analyze its origins in patients receiving anticoagulant drugs. Retrospective analysis of clinical documentation of 238 patients that were consulted for hematuria in 2007–2009 by 5 consultant urologists was performed. In the group of 238 patients with hematuria, 155 (65%) received anticoagulants. Abnormalities of urinary tract were found in 45 (19%) patients. Estimated cost of a single neoplasm detection reached the value of 3252 Euro (mean 3-day hospitalization). The strong correlation between the presence of hematuria and anticoagulant treatment was observed. Authors suggest to redefine the present and future role of hematuria from a standard manifestation of serious urological disease to a common result of a long-term anticoagulant therapy.

A Cough Deteriorating Gross Hematuria: A Clinical Sign of a Forthcoming Life-Threatening Rupture of an Intraparenchymal Aneurysm of Renal Artery (Wunderlich's Syndrome)

“…The most common reasons of gross hematuria are urolithiasis, infectious diseases, and carcinoma of the urinary tract [6, 7]. The majority of the patients with gross hematuria is managed conservatively in an outpatient basis, and strict instructions are given to the patient both for the management and the followup of the hematuria given the fact that macroscopic hematuria has a high diagnostic yield for urological malignancy [6–9].…”

“…The most common reasons of gross hematuria are urolithiasis, infectious diseases, and carcinoma of the urinary tract [6, 7]. The majority of the patients with gross hematuria is managed conservatively in an outpatient basis, and strict instructions are given to the patient both for the management and the followup of the hematuria given the fact that macroscopic hematuria has a high diagnostic yield for urological malignancy [6–9]. The most important factor is the macroscopic hematuria to resolve with adequate water consumption and the blood examinations to show a stable hematocrit which is combined with a stable hemodynamically condition, and if there is no possibility of a urinary retention from a blood clot, then usually the patient is discharged with certain instructions and examinations that should be performed in order to rule out the possibility of cancer.…”

Management of Hematuria All You Always Wanted to Know

“…Gross hematuria occurred in 2,5% of the population and is claimed to involve 4% of all urological visits. Moreover, in a review of observational studies, average annual rates of fatal, and major and all severity bleeding was 0.8%, 4.9% and 15% respectively (Antoniewicz A. et al, 2012). In economic terms, gross hematuria causes spending of millions of dollars worldwide and better management protocols may help reducing costs and patient complications.…”

Intravesical formalin for hemorrhagic cystitis: A contemporary cohort

“…1 One such entity is hemorrhagic cystitis, which is characterized by diffuse bleeding throughout the urothelium and is typically secondary to radiation or chemotherapy exposure. [2][3][4][5] Notably, the presentation of hemorrhagic cystitis may vary from mild, self-limited gross hematuria to refractory, life-threatening hemorrhage with clot retention requiring blood transfusion and emergent surgical or radiological intervention.…”