Blood Clots In Urine Male With Pain – “Hematuria” occurs when the urine is red, brown or tea-colored due to the presence of blood. Hematuria can also be subtle and can only be detected with a microscope or laboratory test.

The blood that flows and mixes with urine can come from anywhere in the urinary system, including the kidneys, ureter, bladder, urethra, and in the case of the prostate.

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The most common causes of hematuria include urinary tract infection (UTI), kidney stones, viral diseases, trauma, bladder cancer, and exercise.

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These causes are divided into glomerular and non-glomerular causes, depending on the involvement of the glomerulus.

Other substances such as certain medicines and foods (e.g. blackberries, beets, food dyes) may cause your urine to turn red.

Msstruction in a woman may also cause hematuria and may result in a positive urine dipstick test for hematuria.

A urine dipstick test may also give a false positive result for hematuria if there are other substances in the urine, such as myoglobin, a protein excreted in the urine during rhabdomyolysis. A positive urine dipstick test result must be confirmed using a microscope, where hematuria is defined as the presence of three or more red blood cells in a high-power field.

Hematuria (blood In The Urine)

If hematuria is detected, a thorough history and physical examination with appropriate further evaluation (e.g., laboratory tests) can help determine the cause.

Many causes may persist as visible or microscopic hematuria, so the differential diagnosis is often based on glomerular and non-glomerular causes.

Hematuria originating from the glomeruli usually appears on urine microscopy as dysmorphic red blood cells (abnormally functioning red blood cells) or red blood cell casts (small tubular structures composed of red blood cell components). This occurs due to the deformation of red blood cells as they pass through the glomerular capillaries into the renal tubules and ultimately into the urinary tract.

Normally, red blood cells should never pass from the glomerular capillaries into the ral tubules, and this is always a pathological process.

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Although the urine dipstick test is able to recognize heme in red blood cells, it also identifies free hemoglobin and myoglobin.

Free hemoglobin can be found in urine as a result of hemolysis, and myoglobin can be found in urine as a result of rhabdomyolysis (muscle breakdown).

Therefore, a positive dipstick result does not necessarily indicate hematuria; rather, urine microscopy showing three or more red blood cells per high-power field confirms hematuria.

In the mother, menstruation may cause hematuria and may result in a positive urine dipstick test for hematuria.

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Menstruation can be ruled out as a cause of hematuria by asking about the history of menstruation and ensuring that a urine sample free of menstrual blood is obtained.

Assessment of hematuria depends on the visibility of blood in the urine (i.e. visible/symptomatic or microscopic hematuria).

Hematuria alone without any accompanying symptoms should raise suspicion of urinary tract cancer until proven otherwise.

The initial evaluation of patients with signs and symptoms consistent with hematuria includes assessing the hemodynamic status, the cause of hematuria, and checking urine drainage. These steps include an assessment of the patient’s heart rate, blood pressure, a physical examination by a healthcare professional, and a blood test to check that the patient’s hemodynamic status is adequate.

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It is important to obtain a detailed history from the patient (i.e., recreational, occupational, and drug exposures) because this information may be helpful in determining the cause of hematuria.

A physical examination may also be helpful in determining the cause of hematuria because certain symptoms detected on a physical examination may suggest specific causes of hematuria.

In this case, initial evaluation of hematuria does not reveal the cause, so a doctor specializing in urology can proceed with the evaluation. This medical evaluation may include, but is not limited to, a history and physical examination by a medical professional, laboratory tests (i.e., blood tests), cystoscopy, and specialized imaging procedures (i.e., CT or MRI).

The first step in assessing red or brown urine is to confirm true hematuria using urinalysis and urinalysis microscopy, where hematuria is defined as the presence of three or more red blood cells in a high-power field.

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When gathering information, it is important to ask about rectal trauma, urologic procedures, multiple sclerosis, and culture-proven urinary tract infection.

If any of these are in the early stages, repeat urine testing under a microscope after 1-2 weeks or after the infection has been treated.

If the results of urinalysis and urine microscopy show glomerular hematuria (as indicated by proteinuria or erythrocyte casts), a nephrologist should be consulted.

If the urinalysis results indicate a non-glomerular origin, a urine microbiological culture should be performed if it has not already been done.

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If the culture is positive (indicating bladder infection), urinalysis and urine microscopic examination should be repeated after treatment to confirm resolution of hematuria.

If the culture is negative or if hematuria persists after treatment, CT urography or oral ultrasound and cystoscopy should be performed.

This section needs updating. Please help update this article to include current information or newly available information. (March 2023)

Once hematuria is detected and confirmed by urinalysis and urinalysis microscopy, the first step in assessing microhematuria is to rule out serious causes.

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The most important causes include urinary tract infection, viral disease, kidney stones, intensive exercise of the rectal muscles, multiple sclerosis, rectal trauma or rectal urological surgery.

Once serious causes have resolved or been treated, repeat urinalysis and microscopic examination of the urine are necessary to ensure that hematuria has ceased.

If hematuria persists (even if the cause is suspected), the next step is to divide the person’s risk of developing urothelial cancer into low, medium or high risk to determine next steps.

To be in the low-risk category, you must meet all of the following criteria: Never smoked tobacco or smoked less than 10 pack-years; is a woman under 50 years of age or a man under 40 years of age; has 3–10 red blood cells per high-power field; he had no previous microscopic hematuria; and has no other risk factors for urothelial carcinoma.

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To be in the medium risk category, you must meet any of the following criteria: smoked for 10-30 pack years; is a woman aged 50-59 or a man aged 40-59; has 11–25 red blood cells in a high-power field; or was previously a low-risk stick with persistent microscopic hematuria and had 3–25 red blood cells in the high-power field.

To be in the high-risk category, you must meet any of the following criteria: smoked more than 30 pack-years; is over 60 years old; or has more than 25 red blood cells in the high-power field on any urine test.

In the case of the low-risk group, the next step is to repeat the urine test using a microscope in 6 months or perform cystoscopy and ral ultrasound.

However, if no cause is detected, hematuria should be re-evaluated within 12 months using urinalysis and urine microscopy.

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Additionally, for all risk categories, if a nephrological cause is suspected, a nephrologist should be consulted.

The pathophysiology of hematuria can often be explained by damage to the structures of the urinary system, including the kidneys, ureter, bladder and urethra, including: prostate.

Common mechanisms include structural damage to the glomerular basement membrane and mechanical or chemical erosion of the urogenital mucosal surface.

If this fails to control the bleeding, proceed to continuous bladder irrigation (CBI) using a three-port catheter.

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If both the large urethral Foley catheter and the CBI fail, an emergency cystoscopy will be required in the operating room.

Urosepsis is defined as sepsis caused by a urinary tract infection and accounts for approximately 25% of all sepsis cases.

Urosepsis results from a systemic inflammatory response to infection and can be recognized by numerous signs and symptoms (e.g., fever, hypothermia, tachycardia, and leukocytosis).

Signs and symptoms that indicate sepsis is caused by a urinary tract infection may include, but are not limited to, flank pain, costovertebral angle pain, pain on urination, urinary regurgitation, and scrotal pain.

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In terms of visibility, hematuria may be visible to the naked eye (called “gross hematuria”) and may be red or brown in color (sometimes referred to as tea-colored), or may be microscopic (i.e., invisible to the eye, but urosepsis has been detected).

In addition to imaging studies, patits may be treated with antibiotics to relieve infection and intravenous fluids to maintain cardiovascular and ral perfusion.

Emergency treatment of the hemodynamic condition when intravenous fluid administration is ineffective may include the use of vasopressors and central venous placement.

Higher rates occur in people over the age of 60 and in people who currently or have smoked in the past.

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When asymptomatic populations are examined by dipstick and/or microscopy, approximately 2% to 3% of people with hematuria have a urologic malignancy.

Risk factors include age (>40 years), male sex, previous or current smoking, exposure to chemicals (e.g. BZS, hydrocarbons, aromatic amines), history of chemotherapy (alkylating agents, ifosfamide), long-term foreign body in the bladder (such as as a bladder catheter), previous pelvic radiotherapy or more than 25 high-power red blood cells

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