Evaluation of haematuria in Khartoum

Four hundred and fifty patients with haematuria were studied over 10 years. Their mean age was 35 years. 103 (23%) patients had past histories of urinary bilharziasis. 207 (46%) patients had associated loin pain at presentation. Intravenous urography could detect the cause of the haematuria in 251 (56%) patients. Cystoscopy was diagnostic in 131 (29%) patients. Other methods of investigation included ultrasonography, selective renal angiography and renal biopsy. The commonest causes of haematuria were urinary calculi in 206 patients (46%), and carcinoma of the bladder in 47 (10%) patients. Twenty patients had squamous cell carcinoma of the urinary bladder in association with urinary bilharziasis, and all were under the age of 40 years, Other causes of haematuria included glomerular diseases in 31 patients, malignant renal tumours in 11, benign renal cysts in five, while it was due to benign prostatic hyperplasia in 31 patients, vesical calculi in 16, cystitis in nine and urethritis in nine patients. Forty two (9%) patients with undiagnosed haematuria were followed for five or more years. Repeat investigations in those with recurring haematuria were negative; except in four patients. Two of those were found to have hyperuricaemia, one renal tuberculosis; and one arterio-venous fistula. None of the patients labelled as having undiagnosed haematuria was found to have developed malignancy in the urinary tract over the subsequent five years. Accordingly, it seems that in the absence of significant signs and symptoms of urological or renal disease other than recurrent haematuria, the probability of finding a significant lesion is quite small.