Gross Hematuria Treatment in Singapore

• Anyone experiencing visible blood in their urine, regardless of accompanying symptoms
• Individuals with gross hematuria accompanied by pain, fever, or urinary symptoms
• Patients with recurrent episodes of blood in urine
• Those with risk factors for urological conditions (smoking history, chemical exposure, family history)
• People over 40 years old with new-onset gross hematuria
• Patients with previous urological conditions experiencing new bleeding episodes

• Heavy bleeding causing clot formation or urinary obstruction
• Gross hematuria with signs of infection (fever, chills, severe pain)
• Blood in urine following recent trauma or injury
• Hematuria accompanied by significant weight loss or constitutional symptoms
• Bleeding in patients on anticoagulation therapy
• Gross hematuria with acute kidney injury indicators

Prompt evaluation is crucial, as gross hematuria may indicate conditions requiring immediate intervention. While not all causes are serious, distinguishing between benign and significant pathology requires professional assessment. Early diagnosis and treatment often lead to more favourable outcomes and may prevent progression of underlying conditions.

Medical management forms the foundation of treatment for many causes of gross hematuria. This approach includes antibiotics for urinary tract infections, medications to help pass kidney stones, or drugs to manage inflammatory conditions affecting the urinary tract. Anti-inflammatory medications may reduce bleeding from conditions like interstitial cystitis, while specific treatments target underlying systemic conditions that manifest with hematuria.

Cystoscopy and ureteroscopy allow direct visualisation and treatment of bleeding sources within the bladder and ureters. These minimally invasive procedures enable removal of bladder tumours, extraction of ureteral stones, and cauterisation of bleeding vessels. Flexible or rigid endoscopes provide access to the entire urinary tract, allowing both diagnosis and treatment during the same procedure. Laser technology or electrocautery can address bleeding lesions immediately upon identification.

When conservative measures prove insufficient, surgical intervention may be necessary. This includes procedures ranging from percutaneous nephrolithotomy for large kidney stones to partial or radical nephrectomy for kidney tumours. Transurethral resection techniques address bladder pathology, while ureteral reimplantation may be required for certain structural abnormalities. Modern surgical approaches prioritise minimally invasive techniques when feasible, reducing recovery time and preserving healthy tissue.

Contemporary urology departments utilise flexible cystoscopes with high-definition imaging, holmium laser systems for stone fragmentation and tissue ablation, and ultrasound guidance for percutaneous procedures. CT urography provides detailed imaging of the entire urinary tract, while specialised coagulation devices control bleeding during procedures. These technologies enable precise treatment with minimal invasive impact.

Initial evaluation begins with comprehensive history-taking and physical examination. Laboratory tests include urinalysis, urine culture, and cytology to check for abnormal cells. Blood tests assess kidney function, coagulation status, and complete blood count. Imaging studies such as CT urography or ultrasound visualise the urinary tract structures. Patients may need to temporarily discontinue blood-thinning medications under medical supervision. Fasting requirements depend on planned procedures, with clear instructions provided beforehand.

Diagnostic cystoscopy typically takes 15-30 minutes under local anaesthesia with lidocaine gel. Patients remain awake but comfortable as the urologist examines the bladder and urethra. For therapeutic procedures, sedation or regional anaesthesia may be administered. The urologist systematically inspects all urinary tract surfaces, identifying and documenting abnormalities. If bleeding sources are found, immediate treatment such as cauterisation or biopsy may be performed. Ureteral stents might be placed to ensure proper drainage if swelling or obstruction is anticipated.

Following the procedure, patients recover in a monitored setting until anaesthesia effects subside. Mild burning during urination and light bleeding are common for 24-48 hours. Increased fluid intake helps flush the urinary system and reduces discomfort. Pain medication prescriptions address any discomfort, while antibiotics prevent infection when indicated. Clear discharge instructions outline warning signs requiring immediate attention. Most diagnostic procedures allow same-day discharge, while therapeutic interventions may require brief hospitalisation.

Initial recovery focuses on monitoring urine colour and volume. Patients should drink 2-3 litres of water daily to maintain good urine flow. Mild pink-tinged urine is expected, but bright red bleeding or clots warrant immediate medical attention. Rest is recommended, avoiding strenuous activities that might provoke bleeding. Pain typically responds well to prescribed medications. Temperature monitoring helps detect early signs of infection. Dietary restrictions are minimal unless specific to the underlying condition being treated.

Gradual return to normal activities occurs as symptoms resolve. Follow-up appointments assess treatment effectiveness and review pathology results if biopsies were taken. Urine may remain slightly discoloured for several days. Patients continue increased fluid intake and complete any prescribed antibiotic courses. Heavy lifting and vigorous exercise should be avoided until cleared by the urologist. Sexual activity can typically resume after initial healing, usually within 3-7 days for diagnostic procedures.

Complete healing depends on the underlying condition and treatment performed. Stone prevention strategies may include dietary modifications and medications. Surveillance protocols for bladder tumours involve regular cystoscopy at prescribed intervals. Patients with chronic conditions receive ongoing management plans. Lifestyle modifications such as smoking cessation impact long-term outcomes. Regular follow-up ensures early detection of recurrence and monitoring of kidney function.

Temporary urinary discomfort following cystoscopy affects most patients, typically resolving within 48 hours. Mild bleeding may persist for several days, particularly after biopsies or stone removal. Urinary frequency and urgency are common but temporary. Some patients experience bladder spasms managed with anticholinergic medications. Mild lower abdominal discomfort responds to simple analgesics. These effects are self-limiting and resolve as healing progresses.

Urinary tract infection occurs in less than 5% of diagnostic procedures, prevented through sterile technique and prophylactic antibiotics when indicated. Urethral stricture formation is uncommon with modern flexible instruments. Bladder perforation, while rare, may occur during therapeutic procedures and typically heals with catheter drainage. Significant bleeding requiring transfusion is exceptional. Allergic reactions to contrast media or medications are possible but manageable with appropriate precautions.

Risk minimisation relies on experienced urologists employing established techniques with appropriate equipment. Pre-procedure assessment identifies patients at higher risk, allowing for modified approaches or additional precautions. Adherence to post-procedure instructions reduces complication rates and ensures prompt recognition of any developing issues.