The evaluation of gross hematuria in anticoagulated patients: efficacy of i.v. urography and cystoscopy

To determine the efficacy of investigating gross hematuria in anticoagulated patients, records were reviewed of 24 patients who had gross hematuria while being treated with warfarin for various thromboembolic disorders. All had IV urography, and half had cystoscopy. Sources of bleeding were found in seven (29%) of 24 patients by IV urography and in five (42%) of 12 patients by cystoscopy. Abnormalities considered responsible for bleeding included renal stones (four), transitional cell carcinoma (one), calcified renal mass (one), lymphoma (one), bladder tumors (two), hemorrhagic cystitis (two), and a bleeding prostate tumor (one). Additionally, an enlarged prostate was the only abnormal finding in five patients. If an enlarged prostate is considered a source of bleeding, the workup that included both IV urography and cystoscopy identified a cause of bleeding in 17 (71%) of 24 patients. The results suggest that IV urography and cystography are warranted in patients who take anticoagulants and who have gross hematuria.