Episode 113. Haematuria with Dr Paul Manohar

Haematuria is a common presenting problem in primary care, with some estimates stating that blood in the urine may be found in between 2-30% of the adult population. Haematuria may be macroscopic or microscopic which is defined as more than 3RBC/HPF and arising from glomerular or non-glomerular origin. Although only 40% of patients with macroscopic haematuria and 14.5% with microscopic haematuria are referred on to urologists for further investigation, the presence of blood in the urine should never be ignored. Ultimately, up to 30% of cases will be shown to have a urological malignancy.

Urinary analysis, looking for infection and including an assessment of protein (questioning a glomerular pathology), and cytology is the standard initial workup. Noting that some patients presenting with altered urine colour they may suspect is blood could be reporting the excretory products of beetroot, blackberries, rhubarb, urobilinogen, or discolouration from drugs such as rifampicin, methyldopa or suphamethoxazole.

It’s important to consider the social history, medical background, gender, and age of patients presenting with haematuria in the clinical workup. Neoplasms of the bladder are more common in men (3x more common than in women), especially in male smokers. The incidence also increased significantly after pelvic radiation, with the use of cyclophosphamide, or after exposure to some pesticides, carbon-containing fuels, or trichloroethylene used in the dry-cleaning business. Each year 3,100 Australians are diagnosed with bladder cancer, which is in the top ten malignancies for men.

In this episode, I was interested to pursue the subject of haematuria further with Urologist Paul Manohar, who undertook training both locally in Australia and internationally. With a focus on minimally invasive laparoscopic and robotic urological surgery and pain management. He also has a strong research interest and holds a position within the Monash University Prostate Cancer Laboratory.

It’s a great pleasure to welcome Paul Manohar to the conversation and thank you for joining us.

References:

Paul Manohar: paulmanoharurology.com.au

Assessment and management of haematuria-RACGP: www1.racgp.org.au

Evaluation of Haematuria in a Large Public Health Care System-NCBI:  www.ncni.nlm.nih.gov

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.