What Is Ureterorrhagia?
Ureterorrhagia is bleeding from the urethra generally caused by irritation. It is characterized by a normal urinary stream accompanied by a few drops of bright red blood at the end or blood spots. The urine flows out of the urinary tract through the urethra. Any irritation or bleeding from the urethra is followed by the occurrence of bright red bleeding in young adolescent boys. Ureterorrhagia is a pediatric condition characterized by staining of the blood in the undergarments usually present between urination and terminal hematuria. Thus, the condition is gross hematuria. The position from which the bleeding occurs from the urethra is away from the point of attachment of the neck of the bladder. Therefore, bleeding occurs from the area of the bladder neck. Sometimes, ureterorrhagia is associated with dysuria (painful urination). The assessment of ureterorrhagia is different from any other condition as it is normal gross hematuria occurring in children. Generally, ureterorrhagia is painless and can resolve on its own over time without medical interference.
What Causes Ureterorrhagia?
The pathology of ureterorrhagia stays ambiguous. The origin of red blood cells in the urine is generally from renal tubules, glomerular, interstitium of the urinary tract, bladder, urethra, and collecting systems. The urine dipstick test containing chemicals is used to detect microscopic blood in the urine (hematuria) and is specific and sensitive. The source of bleeding in pediatrics is generally from the glomeruli region rather than the urinary tract. Abormalities in red blood cells present in the urine are often detected through a microscope. Ureterorrhagia Is linked with abnormality in the red blood cells. Abnormalities in the red blood cells such as changes in their shape and size are characteristic features of glomerular ureterorrhagia. Such deformities in the red blood cells coupled with increased levels of protein in the urine (proteinuria) are the initial signs of ureterorrhagia. An ultrasound is required in case of any signs of glomerular disease in order to assess the pathology in a detailed manner. The functional part of the kidney called the renal parenchyma is subdivided into two parts: renal medulla and renal cortex. Patients with lesions of renal parenchyma are more prone to have minor or major episodes of ureterorrhagia. Ureterorrhagia can be caused by various reasons like irritation, infection, and other injuries. The following are the causes of ureterorrhagia:
Urinary Tract Infections - The bladder portion of the urethra is generally affected either by bacterial or viral infections. A more complicated urinary tract infection involves the infection of the kidneys too.
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Elevated calcium levels in the urine.
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Bacterial or viral infections.
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Kidney stone.
Medications - Ureterorrhagia can be initiated by using inevitable medications such as blood thinners like Aspirin, antibiotics like Penicillin, and sulfa-containing drugs. The other drugs include:
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Aminoglycosides.
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Anticonvulsants.
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Diuretics.
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Cyclophosphamide.
Glomerular Disease - It is the most common cause of ureterorrhagia. It is a disorder of the kidneys with irregular functioning of the kidney. Following are the subtypes of different diseases falling under glomerular diseases:
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Membranous nephropathy.
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Disorders linked with the blood and blood-forming organs (hematological disorders).
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Rapidly progressive glomerulonephritis.
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Goodpasture's disease.
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Coagulopathy.
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Recurrent gross hematuria.
How Is Ureterorrhagia Diagnosed?
To clinically evaluate a child suffering from ureterorrhagia a thorough medical history, and physical examination is required. The medical history, of the patient, must include various factors such as any form of overdone exercise, the recent history of trauma, pain during urination, history of kidney stones or passing a Stone through urine, yet recent history of respiratory organ infection, and any ongoing medication such as NSAIDs. A patient's family history profile should also be made, and cases of hypertension, hematuria, renal stones, renal failures, hemolytic anemia, and jaundice are considered.
Regular monitoring of other major physical conditions related to ureterorrhagia should be made such as inflammation in the face and leg, weight loss, increased urinary frequency, sore throat, and back pain. Heart rate, blood pressure, temperature, and breathing pattern should always be given priority while investigating the patient physically. The presence of hypertension (high blood pressure) and high urine output may indicate some other disorder. Similarly, blood in the urine (hematuria) and skin rashes might also change course in another direction.
The appearance of hematuria (blood in the urine) arising from any dysfunction in the glomerular region needs to be detected by monitoring the urine color. The urine is normally brown or cola-colored under normal circumstances, but on a macroscopic level where the disorder gets origin from the urinary tract, the urine color usually observed is pink or red.
Urethrorrhagia is generally diagnosed based on clinical history alone. However, if there is any anticipation to rule out bleeding then the diagnosis is made based on an ultrasound of the kidneys and bladder. A uroflow study and an ultrasound is required to see if any urine is left in the bladder. Bladder and bowel emptying habits are also discussed by the urologist to further understand the child’s condition.
How Is Ureterorrhagia Treated?
Urethrorrhagia is usually a benign condition. It generally does not need any special treatment. Healthcare providers generally advise patients to stay hydrated and to keep the urine dilute (clear to very light yellow in color), which in turn will prevent any irritation to the lining of the urethra.
Conclusion
Urethrorrhagia can be intermittent in appearance and can come and go, but typically it is self-limiting and does not require prolonged follow-up. In some patients, a history of urethrorrhagia is associated with the development of strictures or narrowing of areas inside the urethra. This commonly occurs over months or years after the bleeding episode. Strictures can result in straining to empty the bladder or difficulty with urination. That is why healthcare providers typically suggest that patients with urethrorrhagia return to the clinic for a follow-up visit. Complete a uroflow examination that measures the urinary flow rate is necessary to make sure there is no evidence of narrowing can help to rule out the disease.
