Urgent considerations
See Differentials for more details
Emergency action for hemodynamically unstable patients
Life-threatening bleeding from the urinary tract is exceedingly rare but may present in select etiologies including renal trauma, hemorrhage from arteriovenous malformations or renal masses, placenta percreta, or hemorrhagic cystitis.[6]
These patients require urgent evaluation in an emergency department or intensive care setting. Hemorrhagic shock from severe bleeding requires aggressive resuscitation with intravenous fluids or blood products. Emergency exploratory surgery or vascular embolization by interventional radiology may be required for control of bleeding. Hemodynamically unstable patients with a poor response to resuscitation may require immediate intervention such as surgery or angioembolization in selected situations.[11]
Catheterization 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 hemorrhagic cystitis intractable to other interventions.[25]
Clot retention
The presence of clots in the urine indicates more significant hematuria. 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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