ACTIVITY DISCLAIMER DISCLOSURE. Charles Carter, MD, FAAFP. Audience Engagement System Step 1 Step 2 Step 3. Learning Objectives
|
|
- Regina Watkins
- 6 years ago
- Views:
Transcription
1 ACTIVITY DISCLAIMER Hematuria: Organizing Your Approach Charles Carter, MD, FAAFP The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. Please note that medical information is constantly changing; the information contained in this activity was accurate at the time of publication. This material is not intended to represent the only, nor necessarily best, methods or procedures appropriate for the medical situations discussed. Rather, it is intended to present an approach, view, statement, or opinion of the faculty, which may be helpful to others who face similar situations. The AAFP disclaims any and all liability for injury or other damages resulting to any individual using this material and for all claims that might arise out of the use of the techniques demonstrated therein by such individuals, whether these claims shall be asserted by a physician or any other person. Physicians may care to check specific details such as drug doses and contraindications, etc., in standard sources prior to clinical application. This material might contain recommendations/guidelines developed by other organizations. Please note that although these guidelines might be included, this does not necessarily imply the endorsement by the AAFP. DISCLOSURE It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. All individuals in a position to control content for this session have indicated they have no relevant financial relationships to disclose. The content of my material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices. Charles Carter, MD, FAAFP Program Director, Family Medicine Residency Program at Palmetto Health Richland, Columbia, South Carolina; Associate Professor, Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia Dr. Carter is a graduate of the University of South Carolina School of Medicine in Columbia. He completed his residency at Palmetto Health Richland in Columbia, and a fellowship at Georgetown University School of Medicine in Washington, DC. He practices in a residency teaching program and cares for mostly underserved patients. He has interests in diabetes, cardiovascular health, headache disorders, and urologic conditions. He feels family physicians are critical partners to help guide patients through complex evaluations and specialty care. Learning Objectives 1. Assess underlying conditions (including infections, kidney diseases and prostate enlargement in men) in patients with hematuria by taking a complete history and physical examination. Audience Engagement System Step 1 Step 2 Step 3 2. Perform appropriate urinalysis, using urine dipstick test or urinalysis microscopic exam, to determine the degree of severity of hematuria. 3. Interpret urinalysis results and establish a coordinated care plan for referral and follow-up to an urologist. 4. Counsel patients on modifying preventable factors for hematuria. 1
2 Hematuria Presence of blood in the urine Gross Hematuria Evident to patient and/or examiner Microhematuria Not apparent to patient and/or examiner Symptomatic Associated/caused by an evident condition Asymptomatic Detected on microscopic urinalysis No clear cause Key Principles Substantial overlap in differential for gross and microscopic hematuria Consider and assess patients for urinary malignancy risk factors Finding an evident cause doesn t necessarily rule out other co-existing causes Evaluation and follow-up often longitudinal Epidemiology Hematuria is a relatively common finding in ambulatory practice Prevalence estimates vary: 1%-18% Pretest likelihood of finding significant cause is >10% with gross hematuria Malignancy rates widely vary for microhematuria. Best evidence is 3.3% Davis R, Jones S, Barocas DA, et al. Diagnosis, Evaluation, and Follow up of Asymptomatic Microhematuria (AMH) in Adults: AUA Guideline. American Urological Association, Limits of the Evidence Barriers to Practice Overall evidence base is limited Mostly observational studies, limited sample sizes Heterogeneity in study design, workups, definitions Some extrapolations from population data Most recommendations are low level and/or expert opinion Source is either Renal or Urinary Tract Image: wikimedia commons Malignancy Renal Bladder Prostate Differential Diagnosis Benign prostatic hyperplasia Infection Urethritis Cystitis Upper UTI Viral illness Menstruation Urolithiasis Trauma Extrinsic Iatrogenic (foley, procedure) Urinary anatomic Urethral stricture Inflammatory processes Medical renal disease Vigorous exercise Benign persistent hematuria 2
3 Which one of the following is the most common risk factor for bladder cancer in the U.S.? 1. Occupational chemical exposure 2. Chronic urinary tract infection 3. Smoking 4. Cancer chemotherapy Urinary Tract Malignancy Risk Factors Smoking Age >50 Cancer treatments: cyclophosphamide, ifosfamide, pelvic irradiation Chronic UTI, Schistosoma haematobium Chronic foreign body Gross hematuria, irritative voiding symptoms Aristolochic (AA) from Aristolochia fangchi (Chinese herbs) Family history and specific genetic mutations Occupational/environmental: Exposure to benzene, aromatic amines, aromatic hydrocarbons Aminobiphenyl Arsenic Image: wikimedia commons National Cancer Institute treatment pdq#link/_17_toc Occupations Most relevant occupational carcinogens banned in U.S. at this point Textiles dyes Tire manufacturing Painters Leather workers and shoemakers Aluminum, iron, steelworkers National Cancer Institute treatment pdq#link/_17_toc Irritative Voiding Symptoms Frequency Urgency Nocturia Urge incontinence However The only clinical finding predictive of urinary malignancy is gross hematuria Schmidt Hansen M, Berendse S, Hamilton W. Br J Gen Pract Nov;65(640):e Should I screen for bladder cancer? USPSTF: Insufficient evidence available to assess balance of benefits and harms (USPSTF I) ACP: Don t use UA to screen for cancer in asymptomatic adults Final Update Summary: Bladder Cancer in Adults: Screening. U.S. Preventive Services Task Force. September Bladder Cancer 4.7% of all cancers ~ 79,030 new cases 16,870 deaths in per 100,000 men and women per year 77% 5-year survival rate Lifetime risk: ~ 2.4 percent of men and women diagnosed U.S. prevalence: 696,440 people (2014 data) National Cancer Institute 3
4 Large variation in approach to hematuria in primary care settings Retrospective review of 449 patients in Texas Only 36% of men and 8% of women were referred urology Advanced age, smoking, presence of urinary symptoms not associated increased urological referral Retrospective review in Tennessee of 2455 primary care patients from Significant variation between those who did and did not undergo evaluation in age, gender, and anticoagulant use GROSS HEMATURIA But also in Urology offices Inconsistent use of cystoscopy Excess use in low-risk patients Insufficient use in higher-risk patients Buteau A, et al. Urol Oncol 2014 Feb;32(2): Friedlander DF, Am J Med Jul;127(7): David SA, et al. Urology Feb;100: Edvard Munch, The Scream, public domain, wikimedia commons William is a 55-year-old man in your office reporting an episode of painless, gross hematuria that he sought emergency care for last week. He underwent non-contrast CT there and it showed at 4 mm stone in the renal pelvis. He has HTN, BPH, a history of kidney stones and has smoked for 20 years. Image: James Heilman, MD, wikimedia commons Which one of the following steps is most appropriate? 1. Urology consultation 2. Repeat urinalysis today 3. Urine culture 4. Reassurance 5. Contrast CT urography Gross Hematuria Patient generally brings to clinical attention May be symptomatic or asymptomatic History and exam may reveal clear cause Urologic evaluation imperative if benign cause not evident Even if benign likely still needed, particularly if patient has risk for urologic malignancy Gross Hematuria Image: wikimedia commons 4
5 Approach to Gross Hematuria Gross Hematuria Obvious benign cause Uncertain cause *Maintain a low threshold for Urology consultation Low risk for urinary malignancy Increased risk for urinary malignancy Evaluate based on history and physical exam Evaluate and address cause Reassess for resolution Address cause if found Reassess and/or obtain Urology consult*, especially if increased urologic malignancy risk Cystoscope. Photograph by Michael Reeve; wikimedia commons All patients 35 and older All patients with risk of urinary tract malignancy Under 35 at clinician s discretion Davis R, Jones S, Barocas DA, et al. Diagnosis, Evaluation, and Follow up of Asymptomatic Microhematuria (AMH) in Adults: AUA Guideline. American Urological Association, MICROSCOPIC HEMATURIA Image: wikimedia commons Joan is a 55-year-old woman with complaint of urinary frequency and prior diagnosis of UTI last year. Dipstick urinalysis: Specific Gravity Glucose Negative Protein 1+ Blood 2+ Nitrite Negative LE Trace RBCs on Microscopy What would be your next step? 1. Urine microscopy 2. Urine culture 3. Empiric treatment for UTI 4. Basic metabolic panel Image: wikimediacommons.org 5
6 This diagnoses microhematuria Image: Santiago Ramón y Cajal ( ). Portrait in 1906, by R. Madrazo y Garreta. Madrid Athenaeum Public domain, wikimedia commons Frettie, Oil dipstick. Wikimedia commons US Navy, Public domain in US, wikimedia commons These don t Definitions Asymptomatic Microhematuria: Presence of 3 or more red blood cells per high power field on urinary microscopy Properly collected specimen No obvious benign cause Davis R, Jones S, Barocas DA, et al. Diagnosis, Evaluation, and Follow up of Asymptomatic Microhematuria (AMH) in Adults: AUA Guideline. American Urological Association, Obtaining Urinalysis Random, midstream clean catch 10 ml of urine 2000 rpm for 10 min 3000 rpm for 5 min Discard supernatant Re-suspend sediment and place on slide Examine HPFs Davis R, et al. Diagnosis, evaluation, and follow up of asymptomatic microhematuria (AMH) in adults: AUA Guideline American Urological Association Evaluation Asymptomatic Hematuria History and physical exam Urinalysis Renal function Other evaluations based on H&P Microhematuria No cause evident Findings of intrinsic renal disease No evident renal disease Concurrent renal evaluation Evaluate urinary tract CT Urography Urologic consultation Benign cause found Treat and reassess 6
7 Evaluation for Renal Disease Renal function testing Bun/Creatinine Proteinuria and Protein/Creatinine ratio Renal Ultrasound Consider Nephrology consultation Barriers to Practice Imaging CT Urography is the preferred method Alternatives MR Urography MR Urography with retrograde pyelogram Non-contrast CT with retrograde pyelogram Renal ultrasound with retrograde pyelogram Davis R, et al. Diagnosis, evaluation, and follow up of asymptomatic microhematuria (AMH) in adults: AUA Guideline American Urological Association CT Urography Renal parenchymal mass SCiardullo via Wikimedia commons CT is the standard, but US emerging A cost-effectiveness analysis suggests: Combining renal US with cystoscopy is the most cost-effective approach vs. CT This wasn t a prospective trial Used literature i.e. simulated CT alone detects 221 cancers at $9,300,000 Ultrasound w/ cystoscopy detects 245 cancers and was most cost-effective at $53,810 per cancer detected Replacing ultrasound with CT detects 1 additional cancer at $6,480,484 per additional cancer detected Halpern JA, Chughtai B, Ghomrawi H. JAMA Intern Med. Published online April 17, 2017 Urologic Consultation Evaluation of a kidney lesion Evaluation of the urinary tract i.e. cystoscopy Alonzo is a 64-year-old man found to have microhematuria on urinalysis obtained as part of work-up for complaint increased voiding at night. He is on warfarin for atrial fibrillation and has a history of HTN, CAD, and tobacco use. His INR is 2.9. Which one of the following is the next most appropriate step? 1. Adjust warfarin to target INR of less than Change warfarin to rivaroxaban 3. Repeat urinalysis in 4 weeks 4. Evaluate for microhematuria 5. Obtain bladder ultrasound and post-void residual 7
8 While anticoagulation may exacerbate bleeding, hematuria should not be attributed solely to the patient being on anticoagulation. Look for an underlying cause. Persistent Microhematuria Persistent asymptomatic microhematuria Microhematuria Negative urologic workup Yearly urinalysis Repeat evaluation in 3 5 years Negative urinalysis Stop UA if negative two consecutive years Davis R, et al. Diagnosis, evaluation, and follow up of asymptomatic microhematuria (AMH) in adults: AUA Guideline American Urological Association Urine Cytology Previously part of long-term surveillance Now recommending against routine use May still play a role in high-risk patients Urine cytology Urinary biomarkers NMP22 BTA-stat Urovysion FISH ImmunoCyt Davis R, et al. Diagnosis, evaluation, and follow up of asymptomatic microhematuria (AMH) in adults: AUA Guideline American Urological Association Practice Recommendations Confirm urine dipstick heme with microscopic urinalysis Gross hematuria warrants thorough evaluation Don t attribute hematuria to anticoagulants Follow hematuria longitudinally. The initial diagnosis isn t necessarily the final one. Include as a problem on your problem list. Questions Thank you! 8
9 ICD 10 Codes Supplemental Billing and Coding Slides Code Descriptor Additional Considerations N02. Recurrent and persistent hematuria Excludes: acute cystitis with hematuria (N30.01); hematuria NOS (R31.9); hematuria not associated with specified morphologic lesions (R31. ) N18. Chronic kidney disease (CKD) Code first any associated: diabetic chronic kidney disease (E08.22, E09.22, E10.22, E11.22, E13.22); hypertensive chronic kidney disease (I12., I13. ) Use additional code to identify kidney transplant status, if applicable, (Z94.0) N28. Other disorders of kidney and ureter, not elsewhere classified N28.89 Other specified disorders of kidney and ureter N28.9 Disorder of kidney and ureter, unspecified Nephropathy NOS; Renal disease (acute) NOS; Renal insufficiency (acute) Excludes: chronic renal insufficiency (N18.9); unspecified nephritic syndrome (N05. ) N29 Other disorders of kidney and ureter in diseases Code first underlying disease, such as: amyloidosis (E85. ); nephrocalcinosis (E83.5); classified elsewhere schistosomiasis (B65.0 B65.9) Excludes disorders of kidney and ureter in: cystinosis (E72.0); gonorrhea (A54.21); syphilis (A52.75); tuberculosis (A18.11) N40. Benign prostatic hyperplasia Includes: adenofibromatous hypertrophy of prostate; benign hypertrophy of the prostate; benign prostatic hypertrophy; BPH; enlarged prostate; nodular prostate; polyp of prostate Excludes: benign neoplasms of prostate (adenoma, benign) (fibroadenoma) (fibroma) (myoma) (D29.1) Excludes: malignant neoplasm of prostate (C61) Q61. Cystic kidney disease Excludes: acquired cyst of kidney (N28.1); Potter's syndrome (Q60.6) R31. Hematuria Excludes: hematuria included with underlying conditions, such as: acute cystitis with hematuria (N30.01); recurrent and persistent hematuria in glomerular diseases (N02. ) 49 Lab CPT Code Labs Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these constituents; non automated, with microscopy ; automated, with microscopy ; non automated, without microscopy ; automated, without microscopy Urinalysis; qualitative or semiquantitative, except immunoassays Urinalysis; bacturiuria screen, except by culture or dipstick Urinalysis; microscopic only Volume measurement for timed collection, each 9
MODULE 5: HEMATURIA LEARNING OBJECTIVES DEFINITION. KEY WORDS: Hematuria, Cystoscopy, Urine Cytology, UTI, bladder cancer
MODULE 5: HEMATURIA KEY WORDS: Hematuria, Cystoscopy, Urine Cytology, UTI, bladder cancer LEARNING OBJECTIVES At the end of this clerkship, the learner will be able to: 1. Define microscopic hematuria.
More informationASYMPTOMATIC MICROSCOPIC HEMATURIA IN WOMEN JOLYN HILL, MD ASSISTANT PROFESSOR, CLINICAL UROGYNECOLOGY FEBRUARY14, 2017
ASYMPTOMATIC MICROSCOPIC HEMATURIA IN WOMEN JOLYN HILL, MD ASSISTANT PROFESSOR, CLINICAL UROGYNECOLOGY FEBRUARY14, 2017 DISCLOSURES No financial disclosures Urogynecologist via Ob/Gyn pathway ASYMPTOMATIC
More informationH(a)ematuria. FX Keeley Consultant Urologist Bristol Urological Institute
H(a)ematuria FX Keeley Consultant Urologist Bristol Urological Institute From Philadelphia to Bristol, England Southmead Hospital, 1916 Southmead Hospital, 2013 Southmead Hospital, 2014 H(a)ematuria Blood
More informationAdvanced Pathophysiology Unit 7: Renal-Urologic Page 1 of 6
Advanced Pathophysiology Unit 7: Renal-Urologic Page 1 of 6 Learning Objectives for this File: 1. Understand how clinical presentation drives the diagnostic workup 2. Recognize how patient education is
More informationDipstick Urinalysis as a Test for Microhematuria and Occult Bladder Cancer
Bladder Cancer 3 (2017) 45 49 DOI 10.3233/BLC-160068 IOS Press Research Report 45 Dipstick Urinalysis as a Test for Microhematuria and Occult Bladder Cancer Richard S. Matulewicz a,b,, John Oliver DeLancey
More informationBladder Cancer Knowing the Risks and Warning Signs. Part II: Warning Signs
Bladder Cancer Knowing the Risks and Warning Signs Part II: Warning Signs May 8, 2018 Presented by: is the Director of Urologic Oncology at MedStar Washington Hospital Center and an Assistant Professor
More informationReviewer's report. Version:1Date:31 January Reviewer:IOANNIS LEOTSAKOS. Reviewer's report:
Reviewer's report Title:A segregation index combining phenotypic (clinical characteristics) and genotypic (gene expression) biomarkers from a urine sample to triage out patients presenting with hematuria
More information10/23/2012 CASE STUDIES: RENAL AND UROLOGIC IMPAIRMENTS. 1) Are there any clues from this history that suggest a particular diagnosis?
Case # 1 An underwriter enters your office, hands you a sheet of paper, and asks What do you think? Can we make an offer? You look at the paper and see it s lab results on a 60 year male looking for $500,000
More informationHey Doc, there s blood in my urine Evaluation of hematuria. Christian S. Kuhr, MD FACS May 4, 2018
Hey Doc, there s blood in my urine Evaluation of hematuria Christian S. Kuhr, MD FACS May 4, 2018 Objectives Understand the algorithm for hematuria evaluation Know the differential diagnosis for hematuria
More informationHaematuria and Modern Bladder Cancer Treatment
Haematuria and Modern Bladder Cancer Treatment Mr Nikhil Vasdev MBBS MRCS MCh(Urol) FRCS(Urol) RCSEng/BAUS Robotic Fellowship Accredited and Trained Consultant Urological and Robotic Surgeon Hertfordshire
More informationMEDICAL POLICY SUBJECT: URINARY TUMOR MARKERS FOR BLADDER CANCER. POLICY NUMBER: CATEGORY: Technology Assessment
MEDICAL POLICY SUBJECT: URINARY TUMOR MARKERS FOR PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including
More informationBladder Cancer in Primary Care. Dr Penny Kehagioglou Consultant Clinical Oncologist
Bladder Cancer in Primary Care Dr Penny Kehagioglou Consultant Clinical Oncologist Objectives Patient presentation in primary care Investigating bladder cancer Management of bladder cancer Differential
More informationCorporate Medical Policy
Corporate Medical Policy Urinary Tumor Markers for Bladder Cancer File Name: Origination: Last CAP Review: Next CAP Review: Last Review: urinary_tumor_markers_for_bladder_cancer 5/2011 11/2017 11/2018
More informationL. Alexandre Frigini MD; Aaron Thomas, MD; Veronica Lenge de Rosen, MD
Computed Tomography Urography (CTU) for Evaluation of Asymptomatic microscopic hematuria. Is intravenous contrast administration warranted for all patients? A retrospective evaluation utilizing ACR s Appropriateness
More informationDr Anna Lawrence. Mr Simon Van Rij
Mr Simon Van Rij Urologist OneSixOne Urology Auckland Dr Anna Lawrence Urologist Auckland Surgical Centre Auckland 8:30-9:25 WS #94: Management of Common Urologic Problems in General Practice 9:35-10:30
More informationHMM 4401 Genito-urinary tract diseases
HMM 4401 Genito-urinary tract diseases Urine production Core elements: Glomerulus, proximal and distal convoluted tube, loop of Henle, collecting tubules, ureters, bladder, sphincter, uretra, and out
More informationClinical Study Bladder Tumor in Women with Microscopic Hematuria: An Iranian Experience and a Review of the Literature
Advances in Urology Volume 2009, Article ID 231861, 5 pages doi:10.1155/2009/231861 Clinical Study Bladder Tumor in Women with Microscopic Hematuria: An Iranian Experience and a Review of the Literature
More informationOP-10: ABDOMEN CT USE OF CONTRAST MATERIAL
Description of Measure OP-10: ABDOMEN CT USE OF CONTRAST MATERIAL This measure calculates the percentage of abdomen studies that are performed with and without contrast out of all abdomen studies performed
More informationOverview. Urology Dine and Learn: Erectile Dysfunction & Benign Prostatic Hyperplasia. Iain McAuley September 15, 2014
Urology Dine and Learn: Erectile Dysfunction & Benign Prostatic Hyperplasia Iain McAuley September 15, 2014 Overview Review of the most recent guidelines for ED and BPH ED Guidelines CUA 2006 AUA 2011
More informationACUTE KIDNEY INJURY A PRIMER FOR PRIMARY CARE PHYSICIANS. Myriam Farah, MD, FRCPC
ACUTE KIDNEY INJURY A PRIMER FOR PRIMARY CARE PHYSICIANS Myriam Farah, MD, FRCPC Clinical Assistant Professor Division of Nephrology, University of British Columbia November 2016 1. How to recognize acute
More informationURINANLYSIS. Pre-Lab Guide
URINANLYSIS Pre-Lab Guide NOTE: A very useful Study Guide! This Pre-lab guide takes you through the important concepts that where discussed in the lab videos. There will be some conceptual questions on
More informationDiabetic Nephropathy
Diabetic Nephropathy Outline Introduction of diabetic nephropathy Manifestations of diabetic nephropathy Staging of diabetic nephropathy Microalbuminuria Diagnosis of diabetic nephropathy Treatment of
More informationVeterans and Bladder Cancer webinar. Part I: Medical Overview
Veterans and Bladder Cancer webinar Tuesday March 1, 2016 Part I: Medical Overview Presented by Dr. Jennifer Taylor is an assistant professor of urology at the University of Pittsburgh School of Medicine.
More informationFind Medical Solutions to Your Problems HYDRONEPHROSIS. (Distension of Renal Calyces & Pelvis)
HYDRONEPHROSIS (Distension of Renal Calyces & Pelvis) Hydronephrosis is the distension of the renal calyces and pelvis due to accumulation of the urine as a result of the obstruction to the outflow of
More informationGENERAL URINE EXAMINATION (URINE ANALYSIS)
GENERAL URINE EXAMINATION (URINE ANALYSIS) Physiology Lab-8 December, 2018 Lect. Asst. Zakariya A. Mahdi MSc Pharmacology Background Urine (from Latin Urina,) is a typically sterile liquid by-product of
More informationHematuria. Ramzi El-Baroudy (ESPNT)
Hematuria Ramzi El-Baroudy (ESPNT) Hematuria is the presence of RBCs in urine. If the amount of blood in urine is big enough, the urine will, then, look red. Something which is, undoubtedly, terrifying.
More informationPediatric Nephrology Consult and Referral Guidelines
Pediatric Nephrology Consult and Referral Guidelines Introduction We see children and teens from birth to 21 years. The most common reasons patients are referred to pediatric nephrology services include:
More informationUniversity Medical Center Brackenridge Specialty Clinics. Urology Clinic Worksheet
Urology Clinic Worksheet Distal Stone Thank you for the consult. Please make sure patient is staying well hydrated by drinking at least 2 liters of water/fluids per day, pain is controlled with ibuprofen
More informationRelated Policies None
Medical Policy MP 2.04.07 BCBSA Ref. Policy: 2.04.07 Last Review: 06/22/2017 Effective Date: 06/22/2017 Section: Medicine End Date: 09/27/2018 Related Policies None DISCLAIMER Our medical policies are
More informationAssisting in the Analysis of Urine. Copyright 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Assisting in the Analysis of Urine Urinalysis Why is Urine is analyzed? To detect extrinsic conditions those in which the kidney is functioning normally, but abnormal end-products of metabolism are excreted
More informationACTIVITY DISCLAIMER DISCLOSURE. Alvin B. Lin, MD, FAAFP. Audience Engagement System Step 1 Step 2 Step 3. Learning Objectives.
ACTIVITY DISCLAIMER Colorectal Cancer Alvin B. Lin, MD, FAAFP The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. Please note
More informationBenign Prostatic Hyperplasia (BPH):
Benign Prostatic Hyperplasia (BPH): Evidence Based Guidelines for Primary Care Providers Jeanne Martin, DNP, ANP-BC Objectives 1. Understand the pathophysiology and prevalence of BPH 2. Select the appropriate
More informationLower Urinary Tract Infection (UTI) in Males
Lower Urinary Tract Infection (UTI) in Males Clinical presentation For patients in care homes see UTI in adults where IV Antibiotics in the community may be appropriate (under development) History and
More informationUTI IN ELDERLY. Zeinab Naderpour
UTI IN ELDERLY Zeinab Naderpour Urinary tract infection (UTI) is the most frequent bacterial infection in elderly populations. While urinary infection in the elderly person is usually asymptomatic, symptomatic
More informationRad Lab 4 Unknowns: Genitourinary!
Rad Lab 4 Unknowns: Genitourinary! Peter Clarke MD! Don Di Salvo, MD! Clerkship Directors for Radiology! Harvard Medical School! Brigham and Women s Hospital! Dana Farber Cancer Institute! Case 1: 69 year
More informationIntroduction to Clinical Diagnosis Nephrology
Introduction to Clinical Diagnosis Nephrology I. David Weiner, M.D. C. Craig and Audrae Tisher Chair in Nephrology Professor of Medicine and Physiology and Functional Genomics University of Florida College
More informationBladder Cancer Canada November 21st, Bladder Cancer 2018: A brighter light at the end of the cystoscope
Bladder Cancer Canada November 21st, 2018 Bladder Cancer 2018: A brighter light at the end of the cystoscope Chris Morash MD FRCSC Associate Professor, University of Ottawa Head, Urological Oncology Bladder
More informationYear 1 MBChB Clinical Skills Session Urinalysis
Year 1 MBChB Clinical Skills Session Urinalysis Reviewed & ratified by: Dr V Taylor-Jones & Ms C Tierney. Urinalysis Aims and Objectives Aim: For the student to be able to safely conduct a urinalysis on
More informationBladder Cancer Early Detection, Diagnosis, and Staging
Bladder Cancer Early Detection, Diagnosis, and Staging Detection and Diagnosis Catching cancer early often allows for more treatment options. Some early cancers may have signs and symptoms that can be
More informationTHE PREVALENCE OF HEMATURIA IN DOGS AND CATS
Scientific Works. Series C. Veterinary Medicine. Vol. LXIII (2) ISSN 2065-1295; ISSN 2343-9394 (CD-ROM); ISSN 2067-3663 (Online); ISSN-L 2065-1295 THE PREVALENCE OF HEMATURIA IN DOGS AND CATS Alexandra
More informationBladder cancer - suspected
Background information Information resources for patients and carers Updates to this care map Bladder cancer - clinical presentation History Examination Consider differential diagnoses Clinical indications
More informationAntibiotic Stewardship and the Misdiagnosis of UTI
Antibiotic Stewardship and the Misdiagnosis of UTI Daniel J. Pallin, MD, MPH Director of Research, Department of Emergency Medicine Chairman, Clinical Investigation Committee Brigham and Women s Hospital
More informationUTI Update: Have We Been Led Astray? Disclosure. Objectives
UTI Update: Have We Been Led Astray? KAAP Sept 28, 2012 Robert Wittler, MD 1 Disclosure Neither I nor any member of my immediate family has a financial relationship or interest with any entity related
More informationFive Things Physicians and Patients Should Question
Five Things Physicians 1 2 3 4 5 A routine bone scan is unnecessary in men with low-risk prostate cancer. Low-risk patients (defined by using commonly accepted categories such as American Urological Association
More informationBLADDER CANCER: PATIENT INFORMATION
BLADDER CANCER: PATIENT INFORMATION The bladder is the balloon like organ located in the pelvis that stores and empties urine. Urine is produced by the kidneys, is conducted to the bladder by the ureters,
More informationScott Williams, MD Pediatric Nephrology OLOL Children s Hospital September 29, Controversies in Urinary Tract Infections
Scott Williams, MD Pediatric Nephrology OLOL Children s Hospital September 29, 2013 Controversies in Urinary Tract Infections Disclaimer I have no affiliations with any pharmaceutical or equipment company
More informationTHE PREVALENCE OF HEMATURIA IN DOGS AND CATS
AgroLife Scientific Journal - Volume 6, Number 2, 2017 ISSN 2285-5718; ISSN CD-ROM 2285-5726; ISSN ONLINE 2286-0126; ISSN-L 2285-5718 THE PREVALENCE OF HEMATURIA IN DOGS AND CATS Alexandra Mihaela POPA,
More informationOveractive Bladder: Diagnosis and Approaches to Treatment
Overactive Bladder: Diagnosis and Approaches to Treatment A Hidden Condition* Many Many patients self-manage by voiding frequently, reducing fluid intake, and wearing pads Nearly Nearly two-thirds thirds
More informationMANAGING BENIGN PROSTATIC HYPERTROPHY IN PRIMARY CARE DR GEORGE G MATHEW CONSULTANT FAMILY PHYSICIAN FELLOW IN SEXUAL & REPRODUCTIVE HEALTH
MANAGING BENIGN PROSTATIC HYPERTROPHY IN PRIMARY CARE DR GEORGE G MATHEW CONSULTANT FAMILY PHYSICIAN FELLOW IN SEXUAL & REPRODUCTIVE HEALTH INTRODUCTION (1) Part of male sexual reproductive organ Size
More informationGuidelines for the management of a child with haematuria
Guidelines for the management of a child with haematuria Children s Kidney Centre University Hospital of Wales Cardiff CF14 4XW DISCLAIMER: These guidelines were produced in good faith by the author(s)
More informationPaediatrica Indonesiana. Urine dipstick test for diagnosing urinary tract infection
Paediatrica Indonesiana VOLUME 53 November NUMBER 6 Original Article Urine dipstick test for diagnosing urinary tract infection Syarifah Julinawati, Oke Rina, Rosmayanti, Rafita Ramayati, Rusdidjas Abstract
More informationWhat You Need to Know About Bladder Cancer. Sponsored by:
What You Need to Know About Bladder Cancer Sponsored by: When It's About Your Bladder 1 Your bladder plays an important role in your body by collecting urine from the kidneys, then holding it until you
More informationThe Royal Marsden. MDT case study. Mr Alan Thompson Consultant Urological Surgeon The Royal Marsden
MDT case study Mr Alan Thompson Consultant Urological Surgeon The Royal Marsden 2 The Royal Marsden Case history 56 year old lady from Bangladesh with 5 children Rarely seen her GP over the last 10 years
More informationOutcomes Primary Outcomes Secondary Outcomes Tertiary Outcomes
Urology David Joseph, MD, Chair Hadley Wood, MD Elizabeth Yerkes, MD Dominic Frimberger, MD Michelle Baum, MD Rose Khavari, MD Rosalie Misseri, MD Stacey Tanaka, MD Sharon Baillie, RN Outcomes Primary
More informationTMP/SMZ DS Ciprofloxacin Norfloxacin Ofloxacin Cefadroxil * 30 Amoxicilin 86* 19 25
Evidence-Based Evaluation and Treatment of UTI UTI Prevalence Leslee L. Subak, MD Associate Professor Obstetrics, Gynecology & RS Epidemiology & Biostatistics University of California, San Francisco 50%
More informationManagement of Female Stress Incontinence
Management of Female Stress Incontinence Dr. Arvind Goyal Associate Professor (Urology& Renal Transplant) Dayanand Medical College & Hospital, Ludhiana, Punjab, India Stress Incontinence Involuntary loss
More informationHong Kong College of Surgical Nursing
Hong Kong College of Surgical Nursing Higher Surgical Nursing Training: Part B Specialty - Urological Nursing Curriculum TABLE OF CONTENTS No. Contents Page. Introduction. Aims. Learning Objectives 4.
More informationDecember 22, Earl Berman, MD Attn Medical Review Two Vantage Way Nashville, TN
December 22, 2016 Earl Berman, MD Attn Medical Review Two Vantage Way Nashville, TN 37228 cmd.inquiry@cgsadmin.com Re: Draft Local Coverage Determination - Bladder Tumor Markers (DL36975) Dear Dr. Berman:
More informationURINARY TRACT INFECTIONS
URINARY TRACT INFECTIONS Learning Objectives Identify signs and symptoms that may indicate presence of UTI (both complicated and uncomplicated) List common causative organisms and risk factors for UTIs
More informationCKD FOR PRIMARY CARE MINNESOTA ACADEMY OF PHYSICIANS 2017 HEATHER ANN MUSTER, MD MS
CKD FOR PRIMARY CARE MINNESOTA ACADEMY OF PHYSICIANS 2017 HEATHER ANN MUSTER, MD MS PLoS One. 2014 Nov 26;9(11):e110535. Of the 445 PCPs who enrolled at least 10 patients, 19 (4.3%) had >50% likelihood
More information4 th Year Urology Core Objectives Keith Rourke (Revised June 1, 2007)
4 th Year Urology Core Objectives Keith Rourke (Revised June 1, 2007) I. Genitourinary Trauma: 1. Goal: The student will be able to demonstrate a basic clinical approach to the management & diagnosis of
More informationAlterations of Renal and Urinary Tract Function
Alterations of Renal and Urinary Tract Function Chapter 29 Urinary Tract Obstruction Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract The obstruction
More informationUrinary Cytology. Spasenija Savic Prince Pathology, University Hospital Basel, Switzerland
Urinary Cytology Spasenija Savic Prince Pathology, University Hospital Basel, Switzerland Outline Pre-analytics The Paris System (TPS): Background Diagnostic categories Morphologic criteria for each category
More informationTaking a dip into urinalysis
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Taking a dip into urinalysis Author : Christine Jameison Categories : RVNs Date : July 1, 2009 Christine Jameison RVN, probes
More informationDr. Sanjay Pandeya NEPHROLOGIST
Dr. Sanjay Pandeya NEPHROLOGIST HALTON HEALTHCARE SERVICES, OAKVILLE, ON JOSEPH BRANT HOSPITAL, BURLINGTON, ON [ADJ] ASSISTANT PROFESSOR, MCMASTER UNIVERSITY Approach to Hematuria DR. SANJAY PANDEYA MD.
More informationThe University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Nephrology
The University of Arizona Pediatric Residency Program Primary Goals for Rotation Nephrology 1. GOAL: Understand the general pediatrician's role in diagnosis and management of hypertension in children.
More informationRATIONALE: The organs making up the urinary system consist of the kidneys, bladder, urethra, and ureters.
Chapter 12 Section Review 12.1 1. A. Kidneys RATIONALE: The renal pelvis receives urine from the kidney, travels through the ureters on the way to the bladder, but urine is formed in the kidney. 2. C.
More informationIcd 10 urinary tract infection unspecified
Icd 10 urinary tract infection unspecified 14-10-2015 Common ICD-10 Family Practice Codes. unspecified. Acute Respiratory Infections ( ICD -9-CM. URINARY TRACT INFECTION, CYSTITIS ( ICD -9-CM 595.0 TO
More informationEducational Goals & Objectives
Educational Goals & Objectives The nephrology rotation will provide the resident with an opportunity to evaluate and manage patients across the spectrum of renal disorders in both the inpatient and outpatient
More informationProtocol. Urinary Tumor Markers for Bladder Cancer
Protocol Urinary Tumor Markers for Bladder Cancer (20407) Medical Benefit Effective Date: 01/01/13 Next Review Date: 09/18 Preauthorization No Review Dates: 03/12, 09/12, 09/13, 09/14, 09/15, 09/16, 09/17
More informationUrothelial neoplasia as occupational hazard among furniture workers in Calabar, Nigeria
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 14, Issue 6 Ver. VIII (Jun. 2015), PP 15-19 www.iosrjournals.org Urothelial neoplasia as occupational
More informationDisorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome.
Disorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome. Azotemia and Urinary Abnormalities Disturbances in urine volume oliguria, anuria, polyuria Abnormalities of urine sediment red
More informationUpdate on Haematuria and Bladder Cancer
Update on Haematuria and Bladder Cancer Hugh Mostafid FRCS(urol) FEBU Consultant Urologist, Royal Surrey County Hospital and Honorary Senior Lecturer, University of Surrey Guildford None Declarations Recent
More informationDr. Aso Urinary Symptoms
Haematuria The presence of blood in the urine (haematuria) is always abnormal and may be the only indication of pathology in the urinary tract. False positive stick tests and the discolored urine caused
More informationFive Views of Transitional Cell Carcinoma: One Man s Journey
September 2006 Five Views of Transitional Cell Carcinoma: One Man s Journey Amsalu Dabela, Harvard Medical School III Outline Overview: Renal Anatomy Our Patient s Story Diagnostic Imaging Studies Appearance
More informationBladder Cancer Diagnostic Tests
ISSN (Online): 1694-0784 ISSN (Print): 1694-0814 18 Bladder Cancer Diagstic Tests Shefali Jasra,Rishi Gupta, Shruti Mittal Lingayas Institute of Techlogy and Management Lingayas Institute of Techlogy and
More informationDr. Sanjay Pandeya NEPHROLOGIST
Dr. Sanjay Pandeya NEPHROLOGIST HALTON HEALTHCARE SERVICES, OAKVILLE, ON JOSEPH BRANT HOSPITAL, BURLINGTON, ON [ADJ] ASSISTANT PROFESSOR, MCMASTER UNIVERSITY Copyright 2017 by Sea Courses Inc. All rights
More informationAN APPROACH TO HEMATURIA. Dr Saima Ali
AN APPROACH TO HEMATURIA Dr Saima Ali Definition Microscopic hematuria hematuria is defined as the presence of 5 or more RBCs per high-power field in 3 of 3 consecutive centrifuged specimens obtained at
More informationObstructive Nephropathy
Obstructive Nephropathy Liza A. Lucero RN, FNP-C, MSN Renal Medicine Associates Conflicts No conflict of interests Obstructive Nephropathy Objectives Definition of Obstructive Nephropathy Causes Clinical
More informationNursing Care for Children with Genitourinary Dysfunction I
Nursing Care for Children with Genitourinary Dysfunction I 1 Assessment of renal function Clinical manifestations Laboratory tests Urinalysis Urine culture and sensitivity Renal/bladder ultrasound Testicular
More informationUBC Department of Urologic Sciences Lecture Series. Urological Trauma
UBC Department of Urologic Sciences Lecture Series Urological Trauma Disclaimer: This is a lot of information to cover and we are unlikely to cover it all today These slides are to be utilized for your
More informationAn Undergraduate Syllabus for Urology. Produced on behalf of the British Association of Urological Surgeons. March 2012
An Undergraduate Syllabus for Urology Produced on behalf of the British Association of Urological Surgeons March 2012 Authors H Hashim, P Jones, KJ O Flynn, I Pearce, J Royle, M Shaw, AM Sinclair Correspondence
More informationOriginal Policy Date
MP 2.04.05 Urinary Tumor Markers for Bladder Cancer Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return to
More informationUrogynecology ICD-9 to ICD-10 Crosswalks
1100 Wayne Ave, Suite 825 Silver Spring, MD 20910 301.273.0570 Fax 301.273.0778 info@augs.org www.augs.org Urogynecology ICD-9 to ICD-10 Crosswalks ICD 9 ICD 9 Description ICD 10 Code ICD 10 Description
More informationIs Asymptomatic Microscopic Hematuria Using a Dipstick Reliable?
ARC Journal of Urology Volume 2, Issue 2, 2017, PP 31-35 ISSN No. (Online):2456-060X http://dx.doi.org/10.20431/2456-060x.0202005 www.arcjournals.org Is Asymptomatic Microscopic Hematuria Using a Dipstick
More informationUTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys.
UTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys. 1-3% of Below 1 yr. male: female ratio is 4:1 especially among uncircumcised males,
More informationBACTERIAL CULTURE, URINE
789.00-789.09 ABDOMINAL PAIN 789.60-789.69 ABDOMINAL TENDERNESS 276.2 ACIDOSIS 570 ACUTE AND SUBACUTE NECROSIS OF LIVER 580.0-580.9 ACUTE GLOMERULONEPHRITIS 780.97 ALTERED MENTAL STATUS V44.50-V44.6 ARTIFICIAL
More informationEMPIRICAL TREATMENT OF SELECT INFECTIONS ADULT GUIDELINES. Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection
URINARY TRACT Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection and Asymptomatic Bacteriuria on the VIHA Intranet: https://intranet.viha.ca/departments/pharmacy/clinical_pharmacy/pages/infec
More informationUrinary Biomarkers for Cancer Screening, Diagnosis, and Surveillance
Urinary Biomarkers for Cancer Screening, Diagnosis, and Surveillance Policy Number: 2.04.07 Last Review: 12/2018 Origination: 12/2016 Next Review: 6/2019 Policy Blue Cross and Blue Shield of Kansas City
More information'Diagnostic Stewardship for Urinary Tract Infections. Surbhi Leekha MBBS, MPH Associate Professor, UMSOM Medical Director, Infection Prevention, UMMC
'Diagnostic Stewardship for Urinary Tract Infections Surbhi Leekha MBBS, MPH Associate Professor, UMSOM Medical Director, Infection Prevention, UMMC Objectives Describe the difference between asymptomatic
More informationDr P Sigwadi 30 May 2012
Dr P Sigwadi 30 May 2012 Introduction Haematuria Positive blood on urine dipstick 5 red blood cells/ microliter of urine Prevalence Gross haematuria ( macroscopic) 0.13 % Microscopic- 1.5% Haematuria +
More informationMEDitorial March Bladder Cancer
MEDitorial March 2010 Bladder Cancer Last month, my article addressed the issue of blood in the urine ( hematuria ). A concerning cause of hematuria is bladder cancer, a variably malignant tumor starting
More informationASPIRES Urinary Tract Infection Algorithm
ASPIRES Urinary Tract Infection Algorithm Dr. Jennifer Grant Dr. Tim Lau Donna Leung February 2013 VCH Antimicrobial Stewardship 1 Programme: Innovation, Research, Education & Safety KEY PRINCIPLES 1.
More informationDiagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline.
Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. TARGET POPULATION Eligibility Decidable (Y or N) Inclusion Criterion non-neurogenic OAB Exclusion Criterion
More informationA Case of Calcified Ureteritis Cystica: An Indiscernible Condition from Ureterolithiasis
Prague Medical Report / Vol. 110 (2009) No. 3, p. 245 249 245) A Case of Calcified Ureteritis Cystica: An Indiscernible Condition from Ureterolithiasis Alicioglu B. 1, Kaplan M. 2, Aktoz T. 3, Atakan I.
More informationRadiological Assessment of the Kidney in Patients with Hematuria
March 2005 Radiological Assessment of the Kidney in Patients with Hematuria Jeremy L. McKay, Harvard Medical School Year III Hematuria Signs and Symptoms Microscopic or gross hematuria Abdominal pain Fever
More informationRenal Disease. Please refer to the assignment page Three online modules TBLs
Renal Disease Please refer to the assignment page Three online modules TBLs 1 Renal Embryology 2 Lab Tests UA CBC Enzymes Creatinine Creatinine clearance Ammonia Abs C Bx 3 BUN Creatinine Creatinine Clearance
More informationLower Urinary Tract Symptoms (LUTS) and Nurse-Led Clinics. Sean Diver Urology Advanced Nurse Practitioner candidate Letterkenny University Hospital
Lower Urinary Tract Symptoms (LUTS) and Nurse-Led Clinics Sean Diver Urology Advanced Nurse Practitioner candidate Letterkenny University Hospital 01/02/2018 Lower Urinary Tract Symptoms LUTS - one of
More information