Imaging in Imaging in HaematuriaHaematuria

Dr. Jaswinder SinghDr. Jaswinder SinghConsultant RadiologistConsultant Radiologist

West Hertfordshire Trust HospitalsWest Hertfordshire Trust Hospitals

Types of haematuriaTypes of haematuria Visible haematuria (VH): also called macroscopic Visible haematuria (VH): also called macroscopic

haematuria or gross haematuria.haematuria or gross haematuria.

Non-visible haematuria (NVH): also called Non-visible haematuria (NVH): also called microscopic haematuria or dipstick positive microscopic haematuria or dipstick positive haematuria: haematuria: – Symptomatic non-visible haematuriaSymptomatic non-visible haematuria (s-NVH): (s-NVH):

associated symptoms include voiding associated symptoms include voiding lower urinary lower urinary tract symptomstract symptoms (LUTS): hesitancy, frequency, urgency, (LUTS): hesitancy, frequency, urgency, dysuria.dysuria.

– Asymptomatic non-visible haematuriaAsymptomatic non-visible haematuria (a-NVH): (a-NVH): incidental detection in the absence of LUTS or upper incidental detection in the absence of LUTS or upper urinary tract symptoms.urinary tract symptoms.

Significant haematuriaSignificant haematuria

is defined as: is defined as: – Any single episode of VH.Any single episode of VH.– Any single episode of s-NVH (in absence Any single episode of s-NVH (in absence

of UTI or other transient causes).of UTI or other transient causes).– Persistent a-NVH (in absence of UTI or Persistent a-NVH (in absence of UTI or

other transient causes). Persistence is other transient causes). Persistence is defined as 2 out of 3 dipsticks positive defined as 2 out of 3 dipsticks positive for NVH.for NVH.

Investigations and Investigations and managementmanagement

Transient causes need to be excluded Transient causes need to be excluded All children with haematuria should All children with haematuria should

be referred.be referred. All definite haematuria, whether All definite haematuria, whether

macroscopic or microscopic, requires macroscopic or microscopic, requires investigation.investigation.

Patients on anticoagulants should Patients on anticoagulants should also be investigated. also be investigated.

NICE referral guidelineNICE referral guideline

The NICE Cancer Referral Guidelines recommend The NICE Cancer Referral Guidelines recommend urgent referral for:urgent referral for:

Patients of any age with painless Patients of any age with painless macroscopic haematuria.macroscopic haematuria.

Aged 40 years and older who present with Aged 40 years and older who present with recurrent or persistent urinary tract recurrent or persistent urinary tract infection associated with haematuria.infection associated with haematuria.

Aged 50 years and older who are found to Aged 50 years and older who are found to have unexplained microscopic haematuria.have unexplained microscopic haematuria.

With an abdominal mass identified clinically With an abdominal mass identified clinically or on imaging that is thought to arise from or on imaging that is thought to arise from the urinary tract.the urinary tract.

Joint Consensus Statement on the Joint Consensus Statement on the Initial Assessment of HaematuriaInitial Assessment of HaematuriaPrepared on behalf of the Renal Prepared on behalf of the Renal

Association and British Association Association and British Association of Urological Surgeons.of Urological Surgeons.

Issue date July 2008Issue date July 2008

Imaging protocolImaging protocol

Painless Haematuria

Macroscopic Microscopic

CTE USRE CTE

further imaging only at specialist request

Age> 50 Age<50

must be proven (i.e. on microscopy) & negative MSU