Question

A 42-year-old man presents with an 8-hour history of testicular pain, which is increasing in

severity. He is in acute distress by the time you see him and complains of groin pain. He

notes some urinary frequency and nausea. His physical ex is unremarkable with

normal testicular and scrotal ex and mild left costovertebral angle tenderness.

Urinalysis reveals significant microscopic hematuria.

Questions:

1. Will you treat and/or refer? What follow-up is needed?

2. What education is needed for this patient for the future?

3. Are there any complementary therapies to assist this patient in control of his underlying condition long range? Support with evidence from the literature.

Answer 1

*Microscopic” means something is so small that it can only be seen through a special tool called a microscope. “Hematuria” means blood in the urine. So, microscopic hematuria, means red blood cells in urine. These blood cells are so small, though, andcan't see the blood when urinating

1) Will you treat and/or refer? What follow-up is needed?

*I will refer te patiend to a physician

*Depending on the condition causing your hematuria, treatment might involve taking antibiotics to clear a urinary tract infection, trying a prescription medication to shrink an enlarged prostate or having shock wave therapy to break up bladder or kidney stones. In some cases, no treatment is necessary.

*FOLLOW UP:

*Hematuria Assessment

*IMAGING OF THE UPPER URINARY TRACT

*Upper urinary tract imaging can occur before consultation with a urologist if microscopic hematuria without a known cause has been confirmed.

* Historically, the preferred choice for upper tract imaging was intravenous pyelography. However, this study has been largely replaced by multiphasic computed tomography (CT) urography, which combines a noncontrast phase to diagnose hydronephrosis and urinary calculi ,

*EVALUATION OF THE LOWER URINARY TRACT

*Cystoscopy is recommended in all patients with asymptomatic microscopic hematuria who present with risk factors for malignancy, regardless of age .

*Cystoscopy can identify urethral stricture disease, benign prostatic hyperplasia, and bladder masses

*HOW TO FOLLOW UP LATER:

*If appropriate workup does not reveal nephrologic or urologic disease, then annual urinalysis should be performed for at least two years after initial referral.

*If these two urinalyses do not show persistent hematuria, the risk of future malignancy is less than 1%, and the patient may be released from care.

*However, if asymptomatic microscopic hematuria persists on follow-up urinalysis, a full repeat evaluation should be considered within three to five years of the initial evaluation.

* Patients' risk factors for urologic malignancy should guide clinical decision making about reevaluation.

2) What education is needed for this patient for the future?

*Any signs of pain, fever, illness, cloudy urine, or clots require immediate medical attention.

*A a kidney biopsy may be required to determine the cause and further management.. Family members may also be screened for blood in urine and hearing tests maybe done. In addition, further blood tests may be required. However, biopsy can confirm most of the diseases. If biopsy is normal and there is a familial tract of bleeding, then it has a good prognosis.

*Cleanng the genital area should be advised to patient as the disease come along with urinary tract infection

*The patient is advised to take antibiotics in correct period

*Advice to Stay well hydrated. Drink about eight glasses of fluid daily (more during hot weather).

*Remove the urinary calculi ,as it come along with microscopic hematuria.

*Advice to undergo for trying a prescription medication to shrink an enlarged prostate or having shock wave therapy to break up bladder or kidney stones.

*Avoid salt and salty food

*switch to a less-intense exercise program.

*Advice to avoid smoking cigarettes, which are linked to urinary tract cancers.

3)Are there any complementary therapies to assist this patient in control of his underlying condition long range?

*Depending on the condition causing your microscopic hematuria, treatment might involve taking antibiotics to clear a urinary tract infection, trying a prescription medication to shrink an enlarged prostate or having shock wave therapy to break up bladder or kidney stones. In some cases, no treatment is necessary.

* In general, people with exercise-related microscopic hematuria do not need any treatment other than to modify their exercise programs.

*People with drug-related microscopic hematuria will improve if they stop taking the medication that caused the problem.

*Antibiotics typically will cure infection-related microscopic hematuria.
*For other causes of microscopic hematuria, treatment may be more complex:

• Kidney stones — Smaller stones sometimes can be flushed from the urinary tract by drinking lots of fluids. Larger stones may require surgery or lithotripsy, a procedure that breaks up the stone.
• Trauma — Treatment depends on the type and severity of injuries. In severe cases, surgery may be necessary.
• Tumor in bladder or kidney — Treatment is determined by the type of cancer and how much the cancer has spread (its stage), as well as by the patient's age, general health and personal preferences. The primary types of treatment are surgery, chemotherapy, radiation therapy and immunotherapy, a type of treatment that stimulates the immune system to fight cancer.
• Glomerulonephritis — Treatment may include antibiotics to treat any infection, medications called diuretics that help to increase the amount of urine excreted from the body, medications to control high blood pressure and dietary changes to reduce the work of the kidneys. However, children who develop glomerulonephritis related to a streptococcal infection often recover after antibiotics without needing additional treatment. If it is caused by an autoimmune disorder, such as lupus, medications to suppress the immune system, are usually prescribed.
• Bleeding disorders — Treatment depends on the specific type of bleeding disorder. Patients with hemophilia can be treated with infusions of clotting factors or with fresh frozen plasma, a type of transfusion that provides missing factors.