INTRODUCTION

The diseases of the urinary tract have been an important health

hazard to the human race from the days of antiquity .The history of urinary
disease date back to ancient Egypt more than 7000 years ago when a
bladder stone was discovered in a grave in Egypt, amera by Professor
Elliot. In India Susruta in 500BC described various urinary diseases in his
Samhita.

Disease of urinary tract most commonly present with pain, urinary

frequency and haematuria of these by far most important is haematuria i.e.
the presence of blood in urine. It is interesting how many variations can
occur with what appears to be one single symptom namely haematuria.

The patient may describe initial haematuria, terminal haematuria,

bleeding with clots and perhaps pieces, sometimes so that their urine looks
rather like stale tea.

To describe there are two types of haematuria –Microscopic and

macroscopic. In microscopic variety, the blood in urine is so small that it
can only be seen by microscope. In normal urine also, some amount of red
blood cells remains present but the count is always less then 3 red blood
cells /High power field. If the count is more then 5 RBCs/ HPF in spun
urine or more than 3RBCs/HPF in un-spun urine it is termed as significant1.

In macroscopic haematuria, the urine is pink, red or dark brown and

may even contain small blood clots. Less than 0.5 ml of blood in 500 ml of
urine causes macroscopic haematuria. Depending on the urine pH the
colour of urine may vary from bright red to almost black. Usually the patient
is correct when he/she has noticed the urine to be "bloody." The amount of
blood in urine doesn’t necessarily indicate the seriousness of the
underlying problem. As little as 1ml of blood can turn urine red. According
to the site of bleeding, haematuria can be divided under two subheadings:-
Glomerular mainly due to medical causes, and extra glomerular mainly due
 INTRODUCTION 2

to surgical causes like Benign enlargement of prostate in men over 40

years of age, kidney and bladder calculi, kidney diseases, trauma to the
kidney ,Carcinoma bladder, urethral stricture, etc.

In some people during running and jogging, Haematuria occurs due

to repeated jarring of the urinary bladder which is termed as Joggers
Haematuria. It typically occurs in long-distance runners (10 km), is usually
noted at the conclusion of the run, and rapidly disappears with rest. The
haematuria may be of renal or bladder origin. An increased number of
dysmorphic erythrocytes have been noted in some patients, suggesting a
glomerular origin. Exercise-induced haematuria may be the first sign of
underlying glomerular disease such as IgA nephropathy. Conversely,
cystoscopy in patients with exercised-induced haematuria frequently
reveals punctate hemorrhagic lesions in the bladder, suggesting that the
haematuria is of bladder origin.

Some people pass reddish urine due to excessive consumption of

berries, beets or rhubarb, food coloring, certain laxatives etc. and it is
termed as Pseudohaematuria. In some cases of Haematuria there is no
discernable cause which is termed as Idiopathic Haematuria.

Haematuria, although frightening, is usually not painful unless it is

associated with inflammation or obstruction. Thus, patients with cystitis and
secondary haematuria may experience painful urinary irritative symptoms,
but the pain is usually not worsened with passage of clots. More
commonly, pain in association with haematuria usually results from upper
urinary tract haematuria with obstruction of the ureters with clots. Passage
of these clots may be associated with severe, colicky flank pain similar to
that produced by a ureteral calculus, and this helps identify the source of
the haematuria. The presence of clots usually indicates a more significant
degree of haematuria, and, accordingly, the probability of identifying
significant urologic pathology increases

Haematuria is usually intermittent; bleeding may not occur for

months. Complacency in case of evaluation because bleeding stops
 INTRODUCTION 3

spontaneously must be condemned. Haematuria of any degree should

never be ignored and, in adults, should be regarded as a symptom of
urologic malignancy until proved otherwise.

A comprehensive physical examination and detailed history are

indispensable to the evaluation of haematuria. A urinalysis is to be
obtained and careful microscopic examination is to be done followed by
other useful investigations like culture and sensitivity of urine, x-ray KUB,
intravenous urography, ultrasonography of abdomen, cystoscopy, CT scan
etc as needed.

Diseases of the urinary tract especially urolithiasis in this part of this

country is exceedingly common. However very few reports about the
various aspects of Haematuria due to surgical cause are available
especially in relation to our setup .Hence in this study, an attempt will be
made to study the different clinical aspects of Haematuria due to surgical
causes.

This study entitled “A CLINICAL STUDY ON HAEMATURIA DUE

TO SURGICAL CAUSE” will be carried out in the Department of Surgery
with the following objectives:

1. To find etiology of haematuria due to surgical cause by clinical

assessment and investigation.

2. To assess conservative and surgical treatment subjected to the

patients.

3. To assess ultimate surgical outcome.