Painless hematuria
Introduction
Introduction In countless causes of hematuria, we must be alert to a painless hematuria. This intermittent, painless hematuria is often a clinical manifestation of urinary system tumors. If the hematuria suddenly increases, it is often the late stage of the tumor. . For patients with kidney cancer, 70% have painless hematuria. Kidney cancer is a malignant tumor that originates in the urinary tubular epithelial system of the renal parenchyma. In recent years, most patients with kidney cancer are asymptomatic kidney cancers found during physical examination. These patients account for 50% to 60% of the total number of patients with renal cancer. the above. The most common symptoms in patients with symptomatic kidney cancer are low back pain and hematuria, and a small number of patients come to the hospital with an abdominal mass.
Cause
Cause
For patients with kidney cancer, 70% have painless hematuria, while bladder cancer is 75%. For this reason, for a patient with painless hematuria, the malignant tumor of the urinary tract cannot be easily ruled out before the cause is found. Experts believe that for people over the age of 40, when there is painless intermittent hematuria, the urinary tract malignant tumor should be considered first.
Examine
an examination
Related inspection
Urethral examination cystoscopy
In order to determine the location of hematuria, a three-cup test can be performed in the urine test: if there is blood only in the first cup of urine, it is hematuria. In the second or third cup, there is hematuria, which is terminal hematuria. One, two and three cups have hematuria, which is whole blood urine. The first hematuria is a cancer from the urethra, the terminal hematuria is a cancer from the bladder, and the whole blood urine is from a cancer of the ureter or kidney.
In addition, in order to further clarify the diagnosis, the following checks can also be made:
1, repeatedly looking for cancer cells in the urine, such as finding cancer cells in fresh urine, it will help the diagnosis of bladder cancer.
2, radiological examination, including abdominal plain film, pyelography and renal angiography.
3, B-type ultrasound examination: help to diagnose polycystic kidney and kidney tumors.
4, radionuclide examination, commonly used kidney scan, for the diagnosis of renal tumors.
5, cystoscopy, can directly find the location and nature of bleeding.
6, other examinations: for the source of hematuria can not be determined or suspected from the kidney, you can also do CT scan or kidney biopsy.
Diagnosis
Differential diagnosis
Differential diagnosis of painless hematuria:
1, abdominal pain with hematuria: abdominal pain with hematuria is one of the clinical manifestations of kidney and ureteral stones.
2, hematuria with poor urination: hematuria with poor urination, labor and urination drip, in older men are mostly prostate hypertrophy, in middle-aged men should consider urethral stricture, urethral stones or bladder tumors.
3. Hematuria after strenuous exercise or strong physical labor: Hematuria is one of the symptoms of renal ptosis after strenuous exercise or strong physical labor.
4, hematuria with proteinuria: renal hematuria refers to hematuria derived from glomeruli, clinical manifestations of simple hematuria, or hematuria with proteinuria. If the treatment is not thorough, repeated attacks or treatment failure, the condition can not be effectively controlled, and eventually lead to uremia.
5, intermittent hematuria: hematuria refers to red blood cells 3 / HP in the urine, centrifuged urinary red blood cells > 5 / HP, or 12 hours urine Addis count > 500,000, is a common urinary system symptoms in children. The causes are urinary tract inflammation, tuberculosis, stones or tumors, trauma, drugs, etc., which have a great impact on the body. In recent years, there is no obvious accompanying symptom of hematuria, and most of them are glomerular hematuria, which has been widely regarded and studied. Intermittent hematuria is a symptom that occurs when hematuria occurs.
