Management of atraumatic acute gross hematuria in adults

CT: computed tomography.

* Symptomatic blood loss is rarely from an acute process (eg, ureteroarterial fistula from ureteral stent erosion into an iliac artery) and more likely from chronic blood loss from a urinary system malignancy, radiation cystitis, benign prostatic hypertrophy, or a renal arteriovenous malformation.

¶ If clots are present, a red rubber Robinson catheter is preferred for manual irrigation but will need to be replaced with a three-way catheter if continuous bladder irrigation is needed, thus some experts will initially place a three-way catheter. In a patient with recent urologic surgery that may have affected the integrity of the urethra (eg, prostatectomy, urethroplasty, or neo-bladder), we recommend consulting a urologist before attempting placement.

Δ Refer to UpToDate topic on management of acute gross hematuria for detailed description on how to perform these procedures including fluid amount and type and appropriate monitoring.

◊ Can be expedited (eg, within one week) outpatient evaluation. If a urinary bladder catheter was placed, we typically leave it indwelling in case hematuria recurs. If continuous bladder irrigation was required, we recommend consulting a urologist to discuss endpoints for treatment, expedite further workup, and to arrange for prompt follow-up.

§ Patient may need cystoscopy for bladder irrigation and fulguration of bleeding points. Refer to UpToDate topic on management of acute gross hematuria for other indications for emergency urology consultation.