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‘Emergency chemotherapy’ for bleeding cervical cancer: case series

Shafiee, M.N., NorAzlin, M.I., Lim, P.S., Arifuddin D, Trika I, Hatta, D.

Journal of Surgical Academia, 2012;2(2):35-37.
MyJurnal

Fulminant haemorrhage in cervical cancer leads to severe anaemia and haemodynamic instability. Palliative management includes vaginal packing as temporary measure, radiotherapy and other invasive surgical procedures. High dose emergency chemotherapy is not commonly implemented particularly when complicated with anaemia and renal impairment. We discuss three case series on the usefulness of high dose chemotherapy to combat bleeding from cervical cancer as an emergency treatment. The first case was clinically staged as operable 2A disease with severe anaemia due to bleeding from the tumour mass. The haemoglobin was corrected by blood transfusion while the bleeding was being arrested by high dose chemotherapy. The second case was inoperable with invasion to the bladder mucosa. She had frank haematuria and bleeding from the tumour with severe anaemia. A course of chemotherapy and blood transfusion controlled the bleeding and anaemia was corrected. The third case presented late with obstructive uropathy and anaemia. She required dialysis, blood transfusion and high dose emergency chemotherapy to stop the bleeding before undergoing urinary diversion after an unsuccessful ureteric stenting. High dose chemotherapy consisting cisplatin, vincristine, bleomycin and mitomycin-C has a clinical value in arresting fulminant haemorrhage in cervical cancer.

Matched MeSH terms: Hematuria
[A case of chronic schistosomiasis four years after infestation]

Pedalino M, Vercesi E, Manini C, Piras D, Di Primio OG, Vella R, et al.

Urologia, 2010 Oct-Dec;77 Suppl 17:38-41.
PMID: 21308673

Authors present a case of bilharziosis incidentally diagnosed in a patient undergoing TURB for suspected bladder cancer. The patient, who in 2005 had gone to Malaysia, had been suffering from recurrent hemorrhagic cystitis since 2007, which were treated with antibiotic therapy. In November 2009 he presented to our observation for persistent hematuria, underwent ultrasound examination, fibroscopy and TURB diagnostics for suspicious lesions. The histopathology diagnosis found granulomatous lesions with typical parasites eggs due to schistosomiasis eggs. As a consequence of that, the patient underwent medical therapy. The pathologist's role becomes nullifying not only for the diagnosis of parasitic infections but also for the exclusion or evidence of urothelial squamous neoplasia. The low incidence of this rare parasitic disease in European tourists and the presence of immigrants in our country require to spread the knowledge of these parasites and the most simple tests for early detection.

Matched MeSH terms: Hematuria/etiology*
Fulltext Urinary erythrocyte morphology as a diagnostic aid in haematuria

Ahmad G, Segasothy M, Morad Z

Singapore Med J, 1993 Dec;34(6):486-8.
PMID: 8153706

The value of urinary erythrocyte morphology in diagnosing glomerular and nonglomerular haematuria was studied using phase contrast microscopy in 105 patients with significant haematuria. Fifty-eight (93.6%) out of 62 patients with glomerulonephritis had dysmorphic erythrocytes and 40 (93.1%) out of the 43 patients with nonglomerular disease had isomorphic erythrocytes in the urine. A mixed picture of glomerular and nonglomerular haematuria was seen in 5 patients. The sensitivity was 93.6%, the specificity was 97.7% and the positive predictive value was 98.3% for glomerulonephritis in patients with dysmorphic haematuria. The positive predictive value for a nonglomerular source of bleeding was 96.7% with isomorphic haematuria. It is concluded that phase contrast microscopic examination of erythrocytes in urine is a simple, inexpensive and noninvasive technique that reliably distinguishes between glomerular and nonglomerular bleeding in patients.

Matched MeSH terms: Hematuria/diagnosis*; Hematuria/etiology; Hematuria/urine*
Fulltext Tumoral cystitis in children

Zulfiqar MA, Zaleha AM, Zulkifli I, Chia WY, Samad SA

Med J Malaysia, 1998 Sep;53(3):284-7.
PMID: 10968168

Three children aged 3-11 years had ultrasonography of the urinary tract for the investigation of dysuria and haematuria. A bladder mass was seen in these 3 children. One child had computed tomography scan, cystoscopy and bladder biopsy because rhabdomyosarcoma was considered. The biopsy revealed an inflammatory process. The urine culture of the other 2 children revealed E. coli. On ultrasonography, the inflammatory mass may appear homogeneously hypoechoic or may contain moderate level echoes. The mucosal surface of the mass may be smooth or lobulated. It is important to consider an infective cause for a bladder mass in children because computed tomography, cystoscopy and biopsy may be avoided.

Matched MeSH terms: Hematuria/etiology
Fulltext Trapped cystofix: Laparoscopic modality to untie

Muhamad A, Johan S, Khairuddin A, Hayati F, Payus AO, Zainal Abidin ZA

Urol Case Rep, 2021 Jan;34:101448.
PMID: 33088720 DOI: 10.1016/j.eucr.2020.101448

Suprapubic catheterization (SPC) is a temporary measure to relieve acute urinary retention (AUR). Despite being effective, it can lead to complications such as colon perforation, haematuria, and bladder wall spasm. We present a 52-year-old lady with cystofix for underlying urethral stricture presented with AUR. A new SPC was inserted to drain the urine. However, the SPC had looped and entangled with her cystofix, and laparoscopic removal of cystofix and insertion of a new SPC was done. In conclusion, trapped cystofix to the SPC tube is a potential complication during SPC insertion that can be avoided with appropriate care.

Matched MeSH terms: Hematuria
Fulltext The use of interventional radiology in ruptured solitary kidneys

Lei CC, Khairullah A, Zulfiqar A, Samad AS

Med J Malaysia, 1992 Dec;47(4):320-2.
PMID: 1303487

This case report illustrates how a life-threatening renal bleeding which has failed to be controlled by open surgery can be elegantly managed by a minimally invasive technique of interventional radiology. It also allows maximal conservation of renal tissue so that the patient can avoid chronic dialysis or renal transplantation.

Matched MeSH terms: Hematuria/etiology
Stratifying patients with haematuria into high or low risk groups for bladder cancer: a novel clinical scoring system

Hee TG, Shah SA, Ann HS, Hemdan SN, Shen LC, Al-Fahmi Abdul Galib N, et al.

Asian Pac J Cancer Prev, 2013;14(11):6327-30.
PMID: 24377526

Haematuria is a common presentation of bladder cancer and requires a full urologic evaluation. This study aimed to develop a scoring system capable of stratifying patients with haematuria into high or low risk groups for having bladder cancer to help clinicians decide which patients need more urgent assessment. This cross- sectional study included all adult patients referred for haematuria and subsequently undergoing full urological evaluation in the years 2001 to 2011. Risk factors with strong association with bladder cancer in the study population were used to design the scoring system. Accuracy was determined by the area under the receiver operating characteristic (ROC) curve. A total of 325 patients with haematuria were included, out of which 70 (21.5%) were diagnosed to have bladder cancer. Significant risk factors associated with bladder cancer were male gender, a history of cigarette smoking and the presence of gross haematuria. A scoring system using 4 clinical parameters as variables was created. The scores ranged between 6 to 14, and a score of 10 and above indicated high risk for having bladder cancer. It was found to have good accuracy with an area under the ROC curve of 80.4%, while the sensitivity and specificity were 90.0% and 55.7%, respectively. The scoring system designed in this study has the potential to help clinicians stratify patients who present with haematuria into high or low risk for having bladder cancer. This will enable high-risk patients to undergo urologic assessment earlier.

Matched MeSH terms: Hematuria/diagnosis*; Hematuria/urine*
Severe urological complication of leech bite in the tropics

Hamid MS, Mohd Nor GR

Br J Urol, 1996 Jan;77(1):164-5.
PMID: 8653299
Matched MeSH terms: Hematuria/etiology*
Screening proteinuria and hematuria in Malaysian children

Zainal D, Baba A, Mustaffa BE

Southeast Asian J. Trop. Med. Public Health, 1995 Dec;26(4):785-8.
PMID: 9139395

Screening for proteinuria and hematuria is important in the prevention of chronic renal disease. In Malaysia to date no such attempt has been made to establish the prevalence of proteinuria and hematuria. A total of 45,149 primary school children from three districts in Kelantan were screened for proteinuria and hematuria. They were 23,289 boys and 21,860 girls. The prevalence of abnormal urinary sediments after third screening was 0.17% ie 0.07% were in boys and 0.10% were in girls. The commonest abnormality was proteinuria (0.12%), followed by hematuria (0.03%) and combination of proteinuria and hematuria (0.02%). Hematuria was more commonly seen in girls compared to boys while proteinuria was seen in almost equal proportion in boys and girls. Despite screening large number of children the prevalence of asymptomatic proteinuria and hematuria was far lower than in an earlier reported study. Furthermore the majority had mild abnormalities.

Matched MeSH terms: Hematuria/epidemiology; Hematuria/prevention & control*
Fulltext Schistosoma haematobium infection in Malaysia--a case report

Hung LC, Shekar KC

Med J Malaysia, 1992 Dec;47(4):328-30.
PMID: 1303489

An imported case of Schistosoma haematobium infection presenting with haematuria and proteinuria is described. This would constitute a first case of urinary schistosomiasis in Malaysia. The patient failed to respond to multiple antibiotic treatment and was successfully treated with praziquantel.

Matched MeSH terms: Hematuria/etiology
Fulltext Role of Penile Doppler as a Diagnostic Tool in Penile Fracture

Hassali MA, Nouri AI, Hamzah AA, Verma AK

J Med Ultrasound, 2018 03 28;26(1):48-51.
PMID: 30065514 DOI: 10.4103/JMU.JMU_9_18

Penile fracture is defined as a traumatic rupture of either corpus cavernosum or the tunica albuginea; sometimes it can be both. It may be caused by exotic masturbation acts, sexual intercourse, or other trauma to this area. This can be accompanied by injury to the urethra, which is the cause of hematuria as a symptom for some patients. Typically, diagnosis of penile rupture or fracture depends on clinical examination and history told by the patients. We are stating the importance of medical imaging in the diagnosis of patients with penile fracture by presenting a case of patient suffered from penile fracture after a fall on his penis where it affected the erection of two-third of his penis. In which, the proper diagnosis by imaging studies and taking actions accordingly can save the patients from unnecessary surgeries that indeed increase the bill of the medical care directly and indirectly. Therefore, most patients can be diagnosed cost-effectively and treated surgically without a need to delay surgery, which is often the case if one was to resort to other investigations. Investigations such as retrograde urethrography for suspected urethral injury should only be used when the diagnosis of penile fracture is in doubt.

Matched MeSH terms: Hematuria
Fulltext Renal cell carcinoma with proliferative lupus nephritis

Wong KW

BMJ Case Rep, 2015 Jan 16;2015.
PMID: 25596289 DOI: 10.1136/bcr-2014-208060

We report a case of renal cell carcinoma diagnosed after a patient was treated successfully with intravenous cyclophosphamide for her active proliferative lupus nephritis (classes III and V). After the intravenous cyclophosphamide regimen, the patient was asymptomatic with persistent microscopic haematuria, and no proteinuria. The renal cell carcinoma was located on the left kidney; incidentally, this was where the initial renal biopsy was done to diagnose lupus nephritis.

Matched MeSH terms: Hematuria/etiology
Renal biopsies in children in HUSM, Kelantan: indications, results and complications

Van Rostenberghe H, Nik Abidin NZ, Samarendra S

Malaysian Journal of Child Health, 1997;9(2):166-169.
MyJurnal

During a period of three years (February 1995 --January 1998), 30 biopsies were performed for patients within the paediatric age group in Hospital Universiti Sains Malaysia (HUSM). The majority of these patients (19 cases) had steroid-resistant Nephrotic Syndrome. Other indications were lupus erythematosus (5 cases), acute or chronic glomerulonephritis (5 cases) and infantile nephrotic syndrome (1 case). The biopsy of the 19 cases of steroid-resistant nephrotic syndrome gave the following findings: 10 showed minimal- change nephrotic syndrome, 4 focal segmental glomerulosclerosis, 3 mesangial proliferative glomerulonephritis and one diffuse sclerosing glomerulonephritis while there was insufficient glomeruli for a conclusive diagnosis in one case. The 5 patients with acute/chronic glomerulonephritis showed diffused sclerosing glomerulonephritis. The other 5 patients with lupus nephritis showed mesangial proliferative glomerulonephritis (2) and severe proliferative glomerulonephritis (3). The 5-month-old child with infantile nephrotic syndrome showed mesangial proliferative glomerulonephritis. There were no severe complications noted during or immediately after the procedure. There were 3 cases of gross haematuria, one lasting less than 24 hours and the other two less than

Matched MeSH terms: Hematuria
Fulltext Prevalence and awareness of lower urinary tract symptoms among males in the outpatient clinics of Universiti Kebangsaan Malaysia Medical Centre

Ho, Christopher C.K., Praveen, S., Goh, E.H., Tan, G.H., Badrulhisham, B., Zulkifli, M.Z., et al.

Medicine & Health, 2011;6(2):98-106.
MyJurnal

This study aims to determine the prevalence of lower urinary tract symptoms (LUTS) and level of awareness among male outpatients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A questionnaire consisting of demographic data, questions related to knowledge, attitude and practice on BPH and the International Prostate Symptom Score (IPSS) was used for this study. Uroflowmetry and bladder scan were used to evaluate the function of the urinary tract and severity of BPH. Urine dipstick was done for glycosuria, proteinuria and haematuria. A total of 220 respondents were surveyed. The prevalence of moderately and severely symptomatic LUTS was 42.7%. The most commonly reported LUTS were nocturia (78.2%), frequency (58.2%) and incomplete emptying (44.6%). The prevalence of glycosuria, proteinuria and haematuria were 23.6%, 11.4% and 1.8% respectively. There was a significant association between increasing age with the severity of LUTS (p=0.005). Out of 102 respondents with voided urine volume greater than 150 mL, there was a significant decrease in maximum (Qmax) (p=0.039) and average (Qave) urine flow rates with every 10 years increase of age (p=0.001). The majority of respondents (59.5%) have heard of BPH before. Over 78.2% of the respondents would seek medical attention if they have LUTS with 15.9% saying they would seek traditional treatment. In conclusion, the prevalence of LUTS was high and the level of awareness was satisfactory.
Study site: surgical and medical clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Hematuria
Fulltext Pediatric systemic lupus erythematosus. Retrospective analysis of clinico-laboratory parameters and their association with Systemic Lupus Erythematosus Disease Activity Index score

Nazri SKSM, Wong KK, Hamid WZWA

Saudi Med J, 2018 Jun;39(6):627-631.
PMID: 29915860 DOI: 10.15537/smj.2018.6.22112

OBJECTIVES: To elucidate the clinico-laboratory characteristics associated with pediatric systemic lupus erythematosus (pSLE) patients with higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score in a retrospective cohort of pSLE patients.

METHODS: A retrospective study involving 32 pSLE patients was conducted at Hospital Universiti Sains Malaysia, Kelantan, Malaysia between 2006 and 2017.

RESULTS: Within the group of 32 pSLE patients, 23 were girls and 9 were boys (3:1 ratio). The most common symptom was renal disorder (n=21; 65.6%) followed by malar rash (n=9; 28.1%), oral ulcers (n=7; 21.9%), prolonged fever (n=5; 15.6%) and arthritis (n=4; 12.5%). Antinuclear antibodies (ANA) were detected in all patients and 25 patients (78.1%) were positive for anti-double stranded DNA (anti-dsDNA) antibodies. Eighteen (56.3%) patients had active SLE (SLEDAI ≥6), and these patients were significantly associated with heavy pyuria (p=0.004), a high ANA concentration (1:160; p=0.040, 1:320; p=0.006), elevated ESR (p=0.006), low C3 levels (p=0.008), oral ulcers (p=0.010), heavy hematuria (p=0.017) and heavy proteinuria (p=0.017), lupus erythematosus (LE)-nonspecific lesion manifestations (p=0.019) and malar rash (p=0.044).

CONCLUSION: Pediatric systemic lupus erythematosus patients with higher SLEDAI score were most significantly associated with pyuria, high ANA titers, and elevated ESR.

Matched MeSH terms: Hematuria/etiology
Modeling Urinary Dysfunction After External Beam Radiation Therapy of the Prostate Using Bladder Dose-Surface Maps: Evidence of Spatially Variable Response of the Bladder Surface

Yahya N, Ebert MA, House MJ, Kennedy A, Matthews J, Joseph DJ, et al.

Int J Radiat Oncol Biol Phys, 2017 02 01;97(2):420-426.
PMID: 28068247 DOI: 10.1016/j.ijrobp.2016.10.024

PURPOSE: We assessed the association of the spatial distribution of dose to the bladder surface, described using dose-surface maps, with the risk of urinary dysfunction.
METHODS AND MATERIALS: The bladder dose-surface maps of 754 participants from the TROG 03.04-RADAR trial were generated from the volumetric data by virtually cutting the bladder at the sagittal slice, intersecting the bladder center-of-mass through to the bladder posterior and projecting the dose information on a 2-dimensional plane. Pixelwise dose comparisons were performed between patients with and without symptoms (dysuria, hematuria, incontinence, and an International Prostate Symptom Score increase of ≥10 [ΔIPSS10]). The results with and without permutation-based multiple-comparison adjustments are reported. The pixelwise multivariate analysis findings (peak-event model for dysuria, hematuria, and ΔIPSS10; event-count model for incontinence), with adjustments for clinical factors, are also reported.
RESULTS: The associations of the spatially specific dose measures to urinary dysfunction were dependent on the presence of specific symptoms. The doses received by the anteroinferior and, to lesser extent, posterosuperior surface of the bladder had the strongest relationship with the incidence of dysuria, hematuria, and ΔIPSS10, both with and without adjustment for clinical factors. For the doses to the posteroinferior region corresponding to the area of the trigone, the only symptom with significance was incontinence.
CONCLUSIONS: A spatially variable response of the bladder surface to the dose was found for symptoms of urinary dysfunction. Limiting the dose extending anteriorly might help reduce the risk of urinary dysfunction.

Matched MeSH terms: Hematuria/etiology; Hematuria/physiopathology
Medical aspects of haematuria

Suleiman AB

Ann Acad Med Singap, 1987 Apr;16(2):238-9.
PMID: 3688799

Haematuria is always a significant finding that requires proper evaluation, and investigations may need to be initiated based on an adequate history. A careful urine microscopy of the urine using phase contrast microscopy is essential, and may predict the source of the haematuria based on red cell morphology, and point the direction that appropriate investigation should take. Infection tumours, obstruction; and calculi account for most cases of gross haematuria in adults. In paediatric patients, the causes of gross haematuria are readily apparent in half of the cases, but further investigations are necessary in the other half. All cases of haematuria require prompt evaluation and appropriate investigations to ensure correct and early treatment.

Matched MeSH terms: Hematuria/etiology*; Hematuria/urine
Fulltext Massive, spontaneous ruptured renal subcapsular haematoma following thrombolytic therapy in acute ST-elevation myocardial infarction

Raja Ezman Faridz Raja Shariff, Sazzli Shahlan Kasim

Journal of Clinical and Health Sciences, 2019;4(2):82-85.
MyJurnal

Thrombolytic therapy remains widely used in majority of developing countries, where delivery
of primary percutaneous coronary intervention (PCI) remains a challenge. Unfortunately,
complications following such therapy remains prominent, predominantly bleeding-related
problems. We present a rare case of massive renal subcapsular haemorrhage and hematoma
following thrombolytic therapy. A 61-year old gentleman presented following an episode of
chest pain due to acute ST-elevation myocardial infarction. Due to potential delays in obtaining
PCI, the patient was counselled for thrombolysis using streptokinase which he had consented
to. Unfortunately, within 36 hours of admission, he developed abdominal pain, haematuria,
hypotension and altered mental status, associated with acute drops in haemoglobin levels.
Following initial resuscitation efforts, a Computed Tomography scan of the abdomen was
performed revealing a massive renal subcapsular hematoma, likely secondary to previous
thrombolysis. Renal subcapsular hematoma can either be spontaneous or iatrogenic, the latter
often due to coexisting renal-based neoplasm or vasculitidies. Iatrogenic causes include
trauma, following renal biopsies or anticoagulation therapy amongst a few others. Iatrogenic
renal subcapsular haemorrhage and hematoma formation are rare following thrombolysis. Our
literature search revealed only one other similar case, although this was following
administration of recombinant Tissue Plasminogen Activator in a case of acute ischaemic
cerebrovascular accident. This case highlights the complexity in management, following the
findings in terms of need for cessation of dual antiplatelet therapy and timing for PCI and stent
selection.

Matched MeSH terms: Hematuria
Jering-induced acute renal failure with blue urine

Yong M, Cheong I

Trop Doct, 1995 Jan;25(1):31.
PMID: 7886826 DOI: 10.1177/004947559502500110
Matched MeSH terms: Hematuria/etiology
Fulltext Incidental Detection of Endometriosis with 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in a Patient with Cervical Intraepithelial Neoplasia and Adenomyosis

Khoo ACH, Chew GK

Indian J Nucl Med, 2019 5 2;34(2):162-163.
PMID: 31040534 DOI: 10.4103/ijnm.IJNM_27_19

Endometriosis is commonly associated with chronic pelvic pain and its presentation varies between individuals. The only way to confirm the presence of endometriosis is via keyhole or open surgery. In the presence of hematuria, deep endometriotic infiltration needs to be considered. We share an interesting case highlighting the role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in evaluating a posterior urinary bladder wall lesion and hypodense liver lesions in a middle-aged woman with presenting with frank hematuria in the background of treated cervical intraepithelial neoplasia and adenomyosis.

Matched MeSH terms: Hematuria

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