Unexplained hematuria

Area of Science:

• Urology
• Diagnostic Imaging
• Nephrology

Background:

• Hematuria, or blood in urine, is a common presenting symptom requiring thorough investigation.
• Identifying the underlying cause of hematuria is essential for appropriate patient management and prognosis.

Purpose of the Study:

• To assess the diagnostic yield of initial and repeat investigations for hematuria.
• To determine the incidence of unexplained hematuria and identify associated clinical features.
• To evaluate the efficacy of epsilon aminocaproic acid in specific cases of unexplained hematuria.

Main Methods:

• Prospective study of 270 consecutive patients presenting with hematuria.
• Utilized urography and cystoscopy for initial urinary tract visualization.
• Repeated evaluations and advanced imaging (angiography, CT, ultrasound) for persistent or unclear cases.
• Retrospective analysis of 159 patients with unexplained hematuria.

Main Results:

• Over 90% of hematuria cases had a causative lesion identified by initial urography and cystoscopy.
• Repeat evaluation within 4 months diagnosed previously missed lesions in 4 patients.
• 17% of patients on anticoagulants had an underlying cause for hematuria unrelated to their medication.
• 6% of all patients (12% with microscopic, 4% with gross hematuria) remained undiagnosed despite extensive investigation.
• The triad of gross, total, and painless hematuria was present in 15% of unexplained cases.
• Orally administered epsilon aminocaproic acid benefited patients with heavy unilateral renal bleeding.

Conclusions:

• Initial urography and cystoscopy are highly effective in diagnosing the cause of most hematuria presentations.
• A subset of patients requires repeat or advanced imaging to identify the source of bleeding.
• Unexplained hematuria, though uncommon, necessitates comprehensive diagnostic approaches.
• Epsilon aminocaproic acid may offer a therapeutic option for specific scenarios of unexplained renal hematuria.