Urgent considerations
See Differentials for more details
Emergency action for haemodynamically unstable patients
Life-threatening bleeding from the urinary tract is exceedingly rare but may present in select aetiologies including renal trauma, haemorrhage from arteriovenous malformations or renal masses, placenta percreta, or haemorrhagic cystitis.[6]
These patients require urgent evaluation in an emergency department or intensive care setting. Haemorrhagic shock from severe bleeding requires aggressive resuscitation with intravenous fluids or blood products. Emergency exploratory surgery or vascular embolisation by interventional radiology may be required for control of bleeding. Haemodynamically unstable patients with a poor response to resuscitation may require immediate intervention such as surgery or angio-embolisation in selected situations.[12]
Catheterisation may be necessary, particularly if bladder distension with blood and/or urine is present. Agents such as aminocaproic acid or tranexamic acid can be used in selected situations to reduce bleeding in cases of haemorrhagic cystitis intractable to other interventions.[26]
Clot retention
The presence of clots in the urine indicates more significant haematuria. Blood clots can cause urinary obstruction at the bladder outlet. Irrigation of the bladder, and the possible use of continuous bladder irrigation, may be necessary to prevent clot retention and obstructive renal failure.
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