[Dunn - Macroscopic haematuria](x-devonthink-item://0FD6294F-95FA-4ED7-B51F-C13D0ED87352) ## Macroscopic haematuria **DDx** - trauma — eg catheterisation - always needs Ix in NON-catherised pt - infection — haemorrhagic cystitis - Tumour - 13% of cases if no other cause found - ureteric or [[Renal colic|renal calculi]] - polycystic kidney disease - Glomerular disease - Look for proteinuria , renal impairment, leuks - Idiopathic **Hx** - pattern — - Initial and terminal haematuria suggests lower urinary source - Through all urination suggests upper tract - Pain - Painless suggests malignancy - Bladder volume - heavy haematuria can cause clot retention → inadequate bladder emptying **Ix** - usually CT abdo initially - Will often need cystoscopy > [!doses] Painless Haematuria DDx > - urological malignancy > - infection -- UTI, pyelonephritis > - vascular -- AV fistulae, AAA > - renal -- glomerulonephritis > - coagulopathy -- over anticoagulation, haemophilia > - iatrogenic/traumatic -- post catheter, radiation, biopsy, post-stent ## bladder washout insert the largest 3 way Foley IDC possible - usually 22F - 18-20F sizes can be used if needed - ​smaller sizes are more prone to obstruction - ​manually aspirate clot with a Toomey syringe until clear of clots - commence a bladder washout until haematuria light in colour - monitor input and output volumes closely - output < input indicates obstruction and will require manual aspiration to resolve - ​admission will be required unless haematuria rapidly clears - ​treat the underlying cause