Case Of Hematuria Research Articles

Phase II study 2000mg of intravesical gemcitabine in marker lesions

4593 Background: The purpose of the trial designed for multiple superficial tumors of the bladder is to study the ablative or reductive activity of intravesical Gemcitabine on a papillary marker lesion Leaving a marker may be an interesting strategy: the effectiveness of the intravesical treatment can be assessed in a short period of time and furthermore the response the marker may turn out to be an important prognostic factor when correlated with the further recurrence rate. Gemcitabine can be considerate an ideal endovesical chemotherapy agent due to is high molecular weight, with no systemic absorption. Gemcitabine has been studied as a single agent in advanced or metastatic bladder cancer whit 24–28% of responses Methods: All patients with multiple primary and recurrent resectable histologically Ta T1 papillary TCC of the bladder will be considered for the trial all the visible lesions must be resected, except for one marker lesion The patient will then receive weekly instillations of Gemcitabine 2000mg in 50ml of sterile water during 8 weeks staring within 7–15 days after TUR. Control cystoscopy will be performed 12 weeks after TUR. If the marker lesion is still present or other growths are seen, they will be resected and biopsies of normal bladder mucosa performed. If no lesion is seen, a biopsy at the site of the marker will be taken. Results: We have 42 patients, 28 complete responses (66,6%) 14 non responders (33,3%). From 42 multiple patients, 24 are recurrent and 9 primary; 21 - Ta G1, 8 - TaG2, 4 - TaG3, 1 - T1G1, 28- T1 G2. In the non responders group there were no augmentation on TNM classification. Side effects in 6 patients, 2 had one case of hematuria and 4 had mild to strong dysuria Conclusions: We conclude that gencitabine is an active drug in bladder cancer and it wil be needed a randomized phase III protocol to have more data No significant financial relationships to disclose.

La resección transuretral con solución salina: un logro tecnológico aún no asimilado por la urología

To objectively demonstrate the advantages provided by TURP with saline solution (an adjustment made possible thanks to the technological development of new high frequency current generators), although it surprisingly has been received with scepticism in the urological community. A first group of 51 patients (group A) underwent low hydraulic pressure TURP with a pulsed bipolar system (Gyrus Plasmakinetic, with large loop) using physiologic saline solution as irrigation. A second group of 49 patients underwent low hydraulic pressure TURP with a conventional monopolar system (Erbe 350) using glycine-ethanol solution. A better surgical performance was obtained in the first group, as well as a lower degree of bleeding. No intraoperative complications appear in either group. Only one case of late hematuria was registered one month after surgery in a patient of group A. Pulsed bipolar TURP has a minimal thermal in-depth diffusion, achieves vessel hemostasis by dessication instead of charring, has an extremely precise cutting quality, does not produce neuromuscular stimulation, and makes the use of saline solution irrigation possible. All these translate to lower tissue injury, null risk of sequelae secondary to electric current leak, a finer technique, a lower risk of accidental perforation, and the possibility of duplicate or triplicate the surgical time without risk, especially when working with low hydraulic pressure.

Haematuria as a presentation of metastatic oesophageal carcinoma

Haematuria is a classical symptom of urological disease often signifying a primary bladder cancer. Rarely, however, the presence of blood in the urine can be due to secondary spread of tumours into the bladder from distant sites. Notably this has been reported to occur in breast cancer, malignant melanoma and gastric cancers. Haematuria due to spread from a primary oesophageal cancer to the bladder has never been reported. We present a case of haematuria confirmed histologically to be due to metastases from a primary oesophageal tumour. Oesophageal cancer is capable of spread to all three neighbouring compartments (abdomen, chest and neck) and therefore has the potential to spread to unusual sites. Clinicians should always carefully regard haematuria in a patient previously treated for cancer and retain a high index of suspicion for distant metastases as being the cause.

Radio‐frequency ablation of renal cell carcinoma in patients who were at significant risk

Although radio-frequency ablation (RFA) has been recently applied as a minimally invasive treatment option for renal cell carcinoma (RCC), indication of this modality remains a critical issue due to the lack of complete tumor destruction as well as the uncertainty of its long-term efficacy. We report the efficacy of RFA for nine carefully selected patients with RCC who had significant reason to avoid invasive surgical treatment under general anesthesia. Radio-frequency ablation was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in nine patients with biopsy proven RCC (mean diameter, 38 mm; range, 20-53 mm), who were at significant operative or anesthetic risk for invasive surgery. Follow-up enhanced CT scans or magnetic resonance images were evaluated every 3-6 months and an evaluation of metastasis was performed every 6 months. At a mean follow-up of 17 months, seven (78%) of the nine patients with renal tumor showed no tumor enhancement. The renal function of all patients was well preserved. All patients were able to continue undergoing their respective treatments for active diseases in other organs in parallel to the RFA treatment. No distant metastasis, urine leakage were reported and one case of temporary hematuria and one case of peri-renal hemorrhage not requiring blood transfusion were encountered. Intra-operative ultrasonography was useful in the real-time monitoring of the minimally excessive extension of ablation into the normal parenchyma. Radio-frequency ablation appears to be an effective and safe minimally invasive therapeutic option for selected patients with RCC who have reason to avoid invasive surgery under general anesthesia.

Hematuria masiva por fistula arterio-ureteral

We present a case of massive hematuria from artery-ureteral fistula due to urologic complication of the protesic vascular surgery.These kinds of fistula are a rare case of massive macroscopic hematuria and the commonest clinical presentation is the intermittent hematuria.The only therapeutic possibility is surgical.

Autosomal recessive Alport’s syndrome and benign familial hematuria are collagen type IV diseases

Background: Alport’s syndrome (AS) is a genetically heterogeneous renal hereditary disease. Mutations in collagen type IV genes have been described to be responsible for X-linked (COL4A5), autosomal recessive, and autosomal dominant AS (COL4A3/COL4A4). Moreover, at least 40% of benign familial hematuria (BFH) cases cosegregate with the COL4A3/COL4A4 loci, following a dominant pattern of inheritance. Therefore, it has been suggested that BFH may represent the carrier state for autosomal recessive AS. Methods: We report a mutational study of the COL4A3 and COL4A4 genes in 14 AS and 2 BFH families. When possible, linkage analysis has been performed to confirm the pattern of inheritance. One affected proband from each family underwent mutation screening by single-strand conformation polymorphism/heteroduplex analysis. Results: We identified 13 mutations within the COL4A3 gene and 2 mutations within the COL4A4 gene, 9 of which are first reported here. We also detected 14 polymorphisms within the COL4A3 gene and 15 polymorphisms within the COL4A4 gene, 7 of them not previously described. In 2 of our AS families, we found mutations previously reported for BFH, and we characterized a novel mutation shared by an AS and a BFH family. Conclusion: Collagen type IV nephropathy is an entity in itself, and phenotypic manifestations of COL4A3/COL4A4 mutations may range from monosymptomatic hematuria (BFH) to severe renal failure (AS), depending on the gene dosage. In 3 of our families, we genetically confirmed that BFH represents the carrier state for autosomal recessive AS.

Imaging

Imaging

Oral cyclophosphamide for treatment of pemphigus vulgaris and foliaceus

Background Cyclophosphamide is an alkylating adjuvant used in refractory cases of pemphigus. Objective We sought to evaluate the effectiveness and safety of oral cyclophosphamide in the treatment of patients with pemphigus vulgaris (PV) and pemphigus foliaceus (PF) with refractory disease. Patients We studied 23 patients with pemphigus (20 with PV; 3 with PF) who failed to achieve clinical remissions with the use of prednisone and antimetabolites. Results Complete remission was achieved in 17 patients with PV and 2 with PF. A total of 3 patients with PV failed therapy. A partial remission was achieved in 1 patient with PF. The treatment was administered for a median duration of 17 months with a follow-up period of 27 months. The median time to complete remission was 8.5 months. A total of 9 patients who were severely affected received concomitant plasma exchange. Adverse reactions included 5 cases of hematuria, 6 nonlife-threatening infections, and the development of transitional cell carcinoma of the bladder 15 years after discontinuation of cyclophosphamide in 1 patient. No death was associated with cyclophosphamide treatment. Conclusion Oral cyclophosphamide is an effective adjuvant in the treatment of severe and refractory PV and PF, but requires close monitoring.

Microscopic haematuria as an occult filarial infection in bhubaneshwar an endemic area for bancroftian filariasis.

Sera samples of 7 microscopic haematuria cases collected before and after treatment with Diethylcarbamazine citrate, (DEC), 9 microfilaraemic cases and 19 endemic normal individuals were analysed for filarial antigen and IgG antibody levels. Filarial antigen was detected in 5 of the 7 microscopic haematuria cases, of which 3 turned negative for antigen after treatment with DEC. While none of the 7 haematuria cases were positive for filarial IgG antibodies, before the DEC treatment, all of them turned positive after DEC treatment. The sensitivity and specificity values(to detect mf +ve cases) were 89% and 90% respectively for the detection of filarial antigen and 78% and 95% respectively for the detection of filarial IgG antibodies.

16-Year-Old Boy With Gross Hematuria

16-Year-Old Boy With Gross Hematuria

COMPUTERIZED TOMOGRAPHY TAILORED FOR THE ASSESSMENT OF MICROSCOPIC HEMATURIA

We report the results of a multicenter study of arterial, corticomedullary, nephrographic and excretory phase helical computerized tomography (CT) for detecting and characterizing abnormalities causing asymptomatic microscopic hematuria. We evaluated 350 consecutive patients, including 216 men and 134 women 23 to 88 years old, with asymptomatic microscopic hematuria of undetermined cause at 4 medical centers. Patients with known urological pathology were excluded from study. We performed 4 helical CT sequences, including pre-enhancement phase imaging from kidney to symphysis pubis, arterial phase imaging of the kidney and lower pelvis, corticomedullary nephrographic phase imaging of the kidney and lower pelvis, and excretory phase imaging from kidney to symphysis pubis with 2 to 5 mm. collimation and 1 to 1.5 pitch. Of 171 proved lesions 158 were correctly diagnosed. There were 10 false-positive and 13 false-negative diagnoses, indicating 0.9239 sensitivity, 0.9441 specificity, 0.9404 positive and 0.9285 negative predictive values, (p <0.001). All cases of congenital renal lesions, calculous disease, ureteral lesion and neoplastic lesion of the bladder were correctly diagnosed, as were 40 of 41 inflammatory renal, 21 of 23 renal masses and 13 of 16 inflammatory bladder lesions. In 27 patients with renal calculi the study was limited to pre-enhancement spiral CT. A positive diagnosis rate of 45.1% (158 of 350 cases) for the causes of heretofore refractory cases of hematuria with high sensitivity and specificity attest to the effectiveness of our hematuria CT protocol and support its use.

Computerized tomography tailored for the assessment of microscopic hematuria.

We report the results of a multicenter study of arterial, corticomedullary, nephrographic and excretory phase helical computerized tomography (CT) for detecting and characterizing abnormalities causing asymptomatic microscopic hematuria. We evaluated 350 consecutive patients, including 216 men and 134 women 23 to 88 years old, with asymptomatic microscopic hematuria of undetermined cause at 4 medical centers. Patients with known urological pathology were excluded from study. We performed 4 helical CT sequences, including pre-enhancement phase imaging from kidney to symphysis pubis, arterial phase imaging of the kidney and lower pelvis, corticomedullary nephrographic phase imaging of the kidney and lower pelvis, and excretory phase imaging from kidney to symphysis pubis with 2 to 5 mm. collimation and 1 to 1.5 pitch. Of 171 proved lesions 158 were correctly diagnosed. There were 10 false-positive and 13 false-negative diagnoses, indicating 0.9239 sensitivity, 0.9441 specificity, 0.9404 positive and 0.9285 negative predictive values, (p <0.001). All cases of congenital renal lesions, calculous disease, ureteral lesion and neoplastic lesion of the bladder were correctly diagnosed, as were 40 of 41 inflammatory renal, 21 of 23 renal masses and 13 of 16 inflammatory bladder lesions. In 27 patients with renal calculi the study was limited to pre-enhancement spiral CT. A positive diagnosis rate of 45.1% (158 of 350 cases) for the causes of heretofore refractory cases of hematuria with high sensitivity and specificity attest to the effectiveness of our hematuria CT protocol and support its use.

The incidence of hematuria in middle distance track running.

The purpose of this study was to establish if middle distance track athletes experience hematuria during their competitive season interval workouts and, if so, what type of workout based on intensity and distance was most associated with hematuria. During a 4-week observational period, athletes (n = 10) underwent reagent strip urinalysis before and after their twice weekly interval sessions. Positive samples for hematuria were analyzed microscopically to accurately determine red blood cell (RBC) loss. Seventy-one individual interval workouts were observed, of which 32 cases of hematuria were reported. Nine cases of hematuria exhibited >100 RBC per High Power Field (Hpf). Furthermore, 90% of the athletes experienced post-workout hematuria at least once. The highest incidence of hematuria was observed after workouts run at 110% of VO(2peak) over short (600-1,500 m) to moderate (1,501-3,000 m) distances. All post-exercise cases of hematuria resolved within 2 hr of recovery.

A pilot trial of indinavir, ritonavir, didanosine, and lamivudine in a once-daily four-drug regimen for HIV infection.

To evaluate the tolerance, pharmacokinetics, and virologic and immunologic outcomes of once-daily indinavir, ritonavir, didanosine, and lamivudine in HIV-seropositive individuals. Open-label 24-week pilot study. Ten HIV-seropositive subjects who were either antiretroviral-naive or minimally experienced with short-term single-or dual-nucleoside therapy provided informed consent and were enrolled. All subjects received didanosine (400 mg) 30 to 60 minutes before a meal followed by indinavir (1200 mg), ritonavir (400 mg), and lamivudine (300 mg) concurrent with the aforementioned meal. Safety laboratory tests, including a complete blood cell count and amylase, lipase, liver transaminase, and nonfasting lipid monitoring as well as plasma HIV viral load and CD4+ lymphocyte count, were carried out at monthly intervals. Genotyping was performed at baseline. Pharmacokinetic studies for indinavir and ritonavir were performed at week 8. Nine of 10 subjects completed 24 weeks of therapy. No subject demonstrated primary protease inhibitor mutations at baseline. Toxicities experienced by subjects were typically mild and consistent with those commonly reported for each of the medications, including two cases of hematuria. By week 24, median nonfasting cholesterol and triglyceride levels increased by 49% and 108%, respectively. Median baseline plasma HIV viral load and CD4+ lymphocyte count were 29,292 (4.47 log10) copies/ml and 224 cells/mm3, respectively. Eight of 10 subjects had a plasma HIV viral load of <50 copies/ml by week 12. The 2 subjects with a detectable HIV viral load reached <50 copies/ml by week 28. Median CD4+ lymphocyte counts increased by 193 cells/mm3 at week 24. Indinavir and ritonavir plasma concentrations remained above respective inhibitory and effective concentrations (IC95 and EC50) (uncorrected for protein binding) throughout the 24-hour dosing interval for 6 of 10 and 8 of 10 subjects, respectively. Our pilot study demonstrates excellent virologic suppression despite low minimum protease inhibitor concentrations during a dosing interval in some patients and is supportive of further study.

Frequency of gross hematuria shortly after percutaneous coronary intervention

High level anticoagulation during percutaneous coronary intervention (PCI) is associated with an increased incidence of major and minor bleeding complications. 1 Armstrong P.W. Mant M.J. Bleeding risks, risk factors and management of bleeding complications after treatment with anticoagulant, specific antithrombins, thrombolytics IIb-IIIa receptor blockers. Eur Heart J. 1995; 16: 75-80 Crossref PubMed Google Scholar , 2 Rabah M. Mason D. Muller D.W. Hundley R. Kundley R. Kugelmass A.D. Weiner B. Cannon L. O’Neill W.W. Safian R.D. Heparin after percutaneous intervention (HAPI) a prospective multicenter randomized trial of three heparin regimens after successful coronary intervention. J Am Coll Cardiol. 1999; 34: 461-467 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar , 3 Blankenship J. Bleeding complications of glycoprotein IIb-IIIa receptor inhibitors. Am Heart J. 1999; 138: 287-296 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar Gross hematuria has been reported in 2% to 24% of patients receiving chronic anticoagulation with warfarin and/or aspirin for indications other than PCI. 3 Blankenship J. Bleeding complications of glycoprotein IIb-IIIa receptor inhibitors. Am Heart J. 1999; 138: 287-296 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar , 4 Zweifler A.J. Coon W.W. Willis III, P.W. Bleeding during anticoagulant therapy. Am Heart J. 1966; 71: 118-123 Abstract Full Text PDF PubMed Scopus (25) Google Scholar , 5 Van Savage J.G. Freid F.A. Anticoagulant associated hematuria a prospective study. J Urol. 1995; 153: 1594-1596 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar , 6 Avidor Y. Nadu U. Matzkin H. Clinical significance of gross hematuria and its evaluation in patients receiving anticoagulant and aspirin treatment. Urology. 2000; 55: 22-24 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar Gross hematuria has also been reported in patients receiving fibrinolytic therapy. 7 Garcia-Vicente J.A. Costa Pages J. Salva Lacombe P. Hematuria inducida por fármacos. Med Clin. 1993; 100: 110-114 PubMed Google Scholar Although isolated cases of gross hematuria during administration of glycoprotein IIb/IIIa inhibitors have been reported, 8 Urban P. Chatelain P. Brzostek T. Jaup T. Verine V. Rustishauser W. Bailout coronary stenting with 6F guiding catheters for failed balloon angioplasty. Am Heart J. 1995; 129: 1078-1083 Abstract Full Text PDF PubMed Scopus (8) Google Scholar the incidence and significance of gross hematuria in patients undergoing PCI is unknown. Therefore, the present study was undertaken to determine the frequency and underlying etiology of gross hematuria in patients undergoing PCI.

Red cell traverse through thin glomerular basement membranes

How red cells enter the urinary filtrate in most cases of hematuria of glomerular origin has remained a mystery despite the frequent ultrastructural examination of renal biopsy material. Serial sections of glutaraldehyde-fixed, resin-embedded material from a case of sporadic microhematuria were examined by transmission electron microscopy when the site of a red cell traversing the glomerular capillary wall was fortuitously discovered on routine examination. The red cell assumed a dumbbell shape and traversed a localized gap 2.25 microm in diameter in the glomerular endothelium and basement membrane. Serial sections suggested a transcellular route. Apart from the thinning of the basement membrane (167 nm), there were no other generalized abnormalities. Red cells can traverse through gaps in the glomerular capillary walls to gain access to Bowman's space. This may be the origin of glomerular hematuria in common noninflammatory forms of glomerular disease, including thin basement membrane nephropathy.

Urea resolves gross hematuria in a 15 year old with hemoglobin C trait

Hematuria is a rare complication seen in patients with hemoglobin C trait. We report a 15-year-old African-American female with hemoglobin C trait, who presented with persistent hematuria. None of the urological, serological or histological workups revealed any other pathology. Hematuria failed to respond to all conventional modalities used in the treatment of the same condition seen in sickling hemoglobinopathies. This case is the first known case of persistent hematuria in a pediatric patient with hemoglobin C trait, which resolved with intravenous urea administration.

Urinary tract cancer screening through analysis of urinary red blood cell volume distribution

Hematuria is differentiated between glomerular and urinary tract origins on the basis of urinary red cell morphology. We used this distinction in a program of mass screening for urinary tract cancer to achieve cost-effective and safe hematuria screening. Of a total of 21372 adults (mean age 52.3 years; range 20-79 years) participating in a health screening, 912 (4.3%) had a positive dipstick for hematuria and were enrolled in the present study. Urinary red cell volume distribution curves (RDC), the simplest method of assessing urinary red cell morphology, were calculated and subjects were divided into two groups based on their RDC patterns. Group I subjects had a normocytic or mixed pattern and they were immediately investigated for urinary tract malignancy because of the associated risk for urological disease. Group II subjects had a microcytic pattern and, therefore, were judged to be at a low risk of urologic malignancy and were followed up 3 years later without urologic investigations. Among the 38 subjects in group I (4% of all dipstick-positive subjects), one case of bladder cancer was detected. In the remaining 37 patients, 15 cases of benign diseases were discovered. Group II was composed of 869 subjects (96%). The inquiry into their health status conducted 3 years later revealed that 831 (95.6%) were healthy and, of these, 13 had experienced gross hematuria during the period but urological malignancies were ruled out by their urologists, two (0.2%) had died of diseases other than urological cancer and 36 (4.1%) were lost to follow-up. With our method, total costs have been reduced by 93.8% against a conventional setting of a full evaluation for all cases of hematuria. Microcytic hematuria, accounting for 96% of asymptomatic microhematuria cases in the present study, was not associated with a risk for urinary tract malignancy. Compared with conventional hematuria screening with a complete work-up of all cases of hematuria, investigating only subjects with mixed or normocytic RDC patterns was safe and cost effective.

Relief of Benign Prostatic Hyperplasia-related Bladder Outlet Obstruction after Transarterial Polyvinyl Alcohol Prostate Embolization

JVIR 2000; 11:767–770 THE standard management of benign prostatic hyperplasia (BPH) is based on overall patient health and the severity of symptoms. Voiding difficulties attributable to BPH can be quantified with the International Prostatic Symptom Score, a questionnaire consisting of seven symptom categories, with a range of increasingly severe symptom scores from 0 through 35. The score is based on the severity of each of the following obstructive urinary symptoms: hesitancy, decreased urinary stream, intermittency, sensation of incomplete emptying, nocturia, frequency, and urgency. The questionnaire responses are graded, with each of the seven symptom categories contributing a maximum of 5 points, for a total possible score of 35. Symptoms can be ranked as mild (score, 0–7), moderate (score, 8–19), and severe (score, 20–35) (1). Prostatectomy constitutes the traditional management of gross hematuria and/or severe voiding difficulties secondary to BPH. This can be accomplished by transurethral or open surgical means. Various medications, specifically 5-alpha reductase inhibitors and selective -blockers, can decrease the severity of voiding symptoms secondary to BPH. Symptomatic BPH typically occurs in the sixth and seventh decades; it is this older age group that tends to be affected with comorbid cardiovascular disease. Surgical intervention in this age group is considered to be of high risk. We present a case of persistent hematuria and severe urinary obstructive symptoms secondary to BPH, which failed to respond to multiple attempts at conventional therapy. The patient’s condition was successfully managed with superselective transarterial polyvinyl alcohol (PVA) embolization. CASE HISTORY

VASCULAR EMBOLOTHERAPY-HOW MUCH HAS BEEN ACHIEVED?

Emergency and elective embolotherapy of various systemic arteries in 64 patients was carried out at a tertiary centre of Armed Forces. Specific indications were haemoptysis (n=43), preoperative (n=18), haematuria (n=1), epistaxis (n=1) and chemoembolization (n=1). The procedures were performed with gelfoam pellets (n=46), gelfoam pellets and absolute alcohol (n=1), polyvinyl alcohol particles (PVA) (n=14), steel coils (n=2) and Adriamycin-in-oil emulsion (n=1). Embolotherapy resulted in complete haemostasis in 37 (82.2%) out of 45 cases of haemorrhage. In eight cases (17.8%), it resulted in significant improvement. Complete haemostasis was achieved in both cases of haematuria and epistaxis. Pre-operative embolotherapy resulted in considerable reduction of peroperative blood loss in all the cases. Chemoembolization of Hepatocellular carcinoma resulted in partial regression of the tumour. The purpose of this study was to assess the efficacy, safety and reliability of vascular embolotherapy for control of life threatening haemorrhage and preoperative reduction of lesions.