Hematuria physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Physical examination of the patient with hematuria should be focused on finding the underlying cause. The physical examination findings will vary depending on the etiology, as follows:[1][2]

Vital Signs

  • Blood pressure, heart rate, respiration rate, temperature, and consciousness level are important to assess hemodynamic stability, volume status, and possible presence of shock or sepsis as the treatment of hematuria is driven by the underlying pathophysiology and is in large part conservative.

Skin

Neck

Genitourinary system

  • Flank tenderness;
  • Masses in the flank, abdomen, suprapubic area, or urethra
  • Enlarged, nodular, tender, or fluctuant prostate.

Coagulopathy

Infection

Renal disease

Urethral stricture or benign prostatic hyperplasia

  • Urine flow rate and postvoid residual measurement may be helpful as well.[3]

References

  1. Cohen RA, Brown RS (2003) Clinical practice. Microscopic hematuria. N Engl J Med 348 (23):2330-8. DOI:10.1056/NEJMcp012694 PMID: 12788998
  2. Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol 188 (6 Suppl):2473-81. DOI:10.1016/j.juro.2012.09.078 PMID: 23098784
  3. Wein, Alan (2016). Campbell-Walsh urology. Philadelphia, PA: Elsevier. ISBN 978-1455775675.



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