L'ematuria parla l'urologo dott Carlo Magno
Hematuria secondary to benign prostatic hyperplasia BPH can occur due to a vascular primary gland itself or due to the vascular re-growth of the prostate following a transurethral resection of the prostate TURP.
We aim to evaluate the clinical presentation and management in patients within both these groups. We retrospectively archived the data of men diagnosed with hematuria secondary to BPH from our hematuria clinic database from March and March The median age was 73 years range 45—94 years for both groups. Patients managed with reassurance alone or TURP had no further episodes of hematuria. At a mean follow-up was 18 months range 7—22 months2 patients treated with finasteride re-bled but did require further intervention.
A further 2 men elected to stop finasteride due to erectile dysfunction and gynecomastia respectively. BPH can present with hematuria. Following re-evaluation in a hematuria clinic, the lack of any subsequent cancer diagnosis in these patients suggests that repeat hematuria investigations should be carefully re-considered. The gradual rise in patient referrals to urological clinics is attributed to the increased use of urine dipstick analysis in the community [ 3 ].
Current recommendations from the Department of Health, United Kingdom presume that occult pathology may be present following hematuria presentation and as such should be investigated [ 4 ]. Common causes of hematuria in men include urinary infection, urological malignancy and benign prostatic hyperplasia BPH.
The latter diagnosis often ematuria dopo TURP in vascular enlargement of the prostate leading to hematuria. In clinical practice, these patients present at a designated hematuria clinic resulting in extensive investigations. Variations exist within the literature as to the proportion of patients with normal investigations. Khadra et al.
Treatment for BPH involves medical or surgical management options. A transurethral resection of the prostate TURP is the one of the most common types of surgical management offered.
However, despite this intervention patients can re-present with further hematuria following a TURP. Often, this results in further clinical assessment at the hematuria clinic, which escalates the economic burden and patient anxiety following hematuria investigation. Murakami et al.
However, Khadra et al. Furthermore, some studies have suggested that prolonged bleeding can result in hematuria in otherwise normal patients [ 78 ]. We therefore aim to compare diagnostic and treatment outcomes in patients with BPH. We aim to specifically compare patients who have received a TURP in the past with those presenting for the first time. We hypothesize that BPH patients — re-presenting with hematuria following a TURP — do not warrant further investigation as this rarely provides any new pathology resulting in further treatment.
From 1, patients, 1, patients were male Ematuria dopo TURP out-patient referral process was not necessarily conducted within 2 weeks. The inclusion criteria were the presence of visible and invisible hematuria in a ematuria dopo TURP patient referred to our hematuria clinic.
Evaluation consisted of the recording of basic demographics, history, examination, blood tests, urinalysis, urine culture and cytology. In addition patients underwent a renal ultrasound, either an intravenous urogram or kidney, ureter, and bladder X-ray and flexible cystoscopy.
Patients were subdivided into 2 groups based on final coded diagnosis. This was comparable to the group with previous TURP where the mean age was 75 years range 56—92 years.
The degrees of hematuria were ematuria dopo TURP by type of hematuria, the associated pain and any additional clinical features. Patients referred with painless hematuria formed the largest subgroup within both cohorts. The vast majority Differences between the 2 groups were identified. The majority of patients in both groups presented with signs and symptoms of lower urinary tract symptomology LUTS. This was comparable where Group I showed Further diagnoses included urinary infections and calculi.
All patients in ematuria dopo TURP cohorts were diagnosed with ematuria dopo TURP BPH with 1 patient in Group I diagnosed with bladder calculi. Initial investigations included prostate specific antigen PSAserum full blood count and urea and electrolytes and urinalysis.
PSA analysis was performed in selected patients in both ematuria dopo TURP. The proportion of patients receiving a PSA was identified as Differences were noted between the 2 cohorts in the PSA values obtained. The proportion of normal renal function was comparable in both cohorts: Following urinalysis, all urine samples were sent to microscopy, culture and cytological analysis. The negative urine culture rate was also comparable between the 2 cohorts.
In patients with no previous TURP, This compared with the second cohort where No cytological abnormalities were detected in However, after factoring ematuria dopo TURP and unavailable samples the rate of suspicious cytology showed differences between the 2 cohorts. In Group I, 3. Again, the results were comparable between the 2 groups of patients in all 3 investigative modalities. There were a greater proportion of normal renal ultrasounds and flexible cystoscopies in Group I.
In both cohorts there was no cancer diagnosis. Ematuria dopo TURP final diagnosis was hematuria secondary to BPH in Group I and hematuria ematuria dopo TURP to vascular re-growth of the prostate following a previous TURP in the other group.
Two patients treated with finasteride re-bled but required no intervention. Causes of hematuria in men include urinary infection, urological malignancy and BPH. Vascular enlargement ematuria dopo TURP the prostate often leads to hematuria in male patients. In clinical practice, these patients present at the hematuria clinic and following investigations, if a diagnosis of benign prostatic enlargement is noted, then treatment in the form of medical or surgical options is offered.
Our aim was to identify any differences in clinical assessment outcomes between male patients, presenting with hematuria, pre- and post-TURP. We hypothesized that BPH patients re-presenting with hematuria following a TURP — do not warrant further investigation as this ematuria dopo TURP provides any new pathology resulting in further ematuria dopo TURP.
Our findings ematuria dopo TURP the 2 subgroups were comparable clinically. Painless macroscopic hematuria was the most common presentation ematuria dopo TURP our hematuria ematuria dopo TURP which is in keeping with current accepted documented findings. The majority of investigations were comparable between the groups; however, more abnormal findings were noted post-TURP. However, renal function, urine microscopy, urine culture and urine cytology were all largely negative in both groups.
Furthermore, imaging and cystoscopic findings were significantly unremarkable and subgroup analysis identified Group I patients, with no previous TURP, as having less significant identifiable pathology. There were more patients post-TURP It can be difficult, however, to identify potential malignancy in the primary care setting. Thus, urologists may have to explore better ways of identifying and assessing malignant causes of ematuria dopo TURP with further education of primary care physicians.
Certain trends can be identified from subsequent management. Conservative treatment options included reassurance and ematuria dopo TURP reductase inhibitors such as finasteride. This cohort of patients, both pre- and post-TURP, show investigations do not increase cancer diagnosis.
Furthermore, ematuria dopo TURP results show that re-investigating hematuria does not offer any further information. However, there is obvious selection bias and this remains a small ematuria dopo TURP population. Clearly, a larger, randomisedcontrolled trial would be ideal, but may present ethical dilemmas.
Certain trends can be deduced and we propose that considering invasive and ematuria dopo TURP expensive investigations should only be undertaken if the clinical picture appears suspicious. BPH can represent with further hematuria. Conservative treatment options include reassurance and 5-a reductase inhibitors such as finasteride. The lack of any cancer diagnoses in this cohort of patients suggests that repeat hematuria investigations of flexible cystoscopy and imaging are not necessarily required.
We propose that invasive and more expensive investigations should only be undertaken ematuria dopo TURP the clinical picture appears suspicious.
National Center for Biotechnology InformationU. Journal List Curr Urol v. Curr Urol. Published online Dec Author information Article notes Copyright and License information Disclaimer. Received Sep 1; Accepted May Karger AG, Basel. This article has been cited by other articles in PMC. Abstract Ematuria dopo TURP Hematuria secondary to benign prostatic hyperplasia BPH can occur due to a vascular primary gland itself or due to the vascular re-growth of the prostate following a ematuria dopo TURP resection of the prostate TURP.
Ematuria dopo TURP and Methods We retrospectively archived the data of men diagnosed with hematuria ematuria dopo TURP to BPH from our hematuria clinic database from March and March Results The median age was 73 years range 45—94 years for both groups. Conclusion BPH can present with hematuria.
Key Words: Benign prostatic hyperplasia, Hematuria. Table 1 Hematuria presentations. Open in a separate window. Symptoms and Initial Referral Diagnosis The majority of patients in both groups ematuria dopo TURP with signs and symptoms of lower urinary tract symptomology LUTS.
Investigations Initial investigations included prostate specific antigen PSAserum ematuria dopo TURP blood count and urea and electrolytes and urinalysis.