The management of prostatic haematuria.

Background: Prostatic haematuria is a common clinical problem. In this report, we have reviewed the incidence, precipitating/co morbid factors, treatment and outcome of haematuria in patients with benign prostatic hyperplasia and prostate cancer

Methods: A two year prospective review of 37 patients who presented with haematuria associated with benign prostatic hyperplasia and prostate cancer Each patient had full clinical assessment, including any associated precipitating or co morbid factors. All patients had urethral catheterization; and cystoscopy to exclude bladder tumours or bladder stones. Subsequent management depended on severity of bleeding; and consisted of one of the following: observation only, irrigation only, irrigation and blood transfusion and emergency prostatectomy. Upon stabilization, the definitive treatment in each patient was based on primary pathology.

Results: A total of 134 patients who had either benign prostatic hyperplasia or prostate cancer were treated. Thirty seven (27.6%) patients presented with haematuria. The incidences of haematuria in benign prostatic hyperplasia and prostate cancer were 26.7% and 29.2% respectively. Haematuria was precipitated in 17 (45.9%) patients; while nine (24.3%) patients had 12 associated co morbidities. Seventeen (45.9%) patients had blood transfusion. A total of 34 (91.8%) patients were managed conservatively. There were four (10.8%) deaths.

Conclusion: Prostatic haematuria is a common urologic challenge. In most cases conservative management is the key In the absence of modern facilities, emergency open prostatectomy may be needed to control bleeding, in those in whom conservative approach has failed; or when specifically indicated based on the individual patient or as dictated by other local factors.