Hematuria

　　Hematuria of the bladder is mainly caused by hemorrhagic cystitis. The common causes may include the following possibilities:

　　(I) Pathogenic Bacteria

　　The most common pathogenic bacteria causing non-specific infections of the bladder are Gram-negative bacilli, accounting for more than 70%, including Escherichia coli, Proteus, gas-forming bacilli, Paracolon bacilli, and Pseudomonas aeruginosa, among others. The next most common are Gram-positive cocci, with Staphylococcus and Streptococcus being common, while fungal infections are less common. Many cases observed clinically are mixed infections caused by more than one type of bacteria.

　　(2) Inducing factors

　　All factors that can destroy the normal antibacterial ability of the bladder mucosa, change the normal tissue structure of the bladder wall, and are suitable for bacterial retention, growth, and reproduction can induce the occurrence of cystitis. For example, an overexpanded bladder caused by urinary retention can damage the normal barrier function of the bladder mucosa, residual urine caused by lower urinary tract obstruction cannot effectively expel bacteria into the body, stones, foreign bodies can damage the normal tissue structure of the bladder mucosa, tumors and necrotic tissue are conducive to bacterial growth and reproduction, and if the operator is rough and lacks aseptic awareness during endoscopic urological examination and treatment such as catheterization, urethral dilation, cystoscopy, retrograde pyelography, etc., it also provides an opportunity for bacterial invasion. In addition, cystitis can also be secondary to infections in the same system or adjacent organs, such as inflammation of the kidneys, prostate, vagina, cervix, etc.

　　(3) Infection routes

　　1. Ascending infection: Bacteria enter the bladder through the urethra, which is the most common infection route. Women have shorter and straighter urethras, especially during infancy, wedding period, and pregnancy, which are more prone to cystitis. When urinary tract examination is performed through urethral endoscopic operation, bacteria can be carried into the bladder, and bladder inflammation can also be induced after indwelling catheterization.

　　2. Descending infection: Secondary to kidney infection, bacteria enter the bladder through the ureter with urine.

　　3. Local direct infection: After bladder stenting, the bladder is directly connected to the external skin, and when there is a vesicovaginal fistula or vesicorectal fistula, bacteria can directly enter the bladder through the fistula, causing infection.

　　Urethral hemorrhage usually has less bleeding, and the condition can be controlled after etiological and symptomatic treatment, with few complications. A few patients have severe conditions that can lead to complications:

　　1. Anemia or hemorrhagic shock: Large amounts of acute bleeding can lead to anemia in patients, and even hemorrhagic shock.

　　2. Acute urinary retention: Urethral hemorrhage may form blood clots, block the urethra, and cause acute urinary retention.

　　3. Urethral hemorrhage caused by bladder cancer may lead to serious complications due to tumor metastasis.

　　The clinical manifestations of urethral hemorrhage are roughly divided into two categories:

　　Firstly, sudden onset of hematuria:Its characteristics are sudden onset of hematuria, accompanied by symptoms of bladder irritation such as frequent urination, urgency, and dysuria; cystoscopy can show a smaller bladder volume, congestion and edema of the mucosa, erosion or thinning, and fragile vascular walls.

　　Secondly, refractory hematuria:The characteristics are recurrent hematuria, or persistent hematuria that does not heal for a long time, accompanied by bladder irritation symptoms. Cystoscopy can show bladder shrinkage, bladder contraction, loss of elasticity, mucosal congestion and edema, ulceration and necrosis, or vascular hemorrhage.

　　Urethral hemorrhage is one of the phenomena that困扰 many friends. Urethral hemorrhage is not a complex phenomenon; it can still be prevented as long as daily care is paid attention to and medication is not used recklessly.

　　One, drink plenty of water, preferably two liters a day.

　　2. Urinate in time and do not hold urine.

　　3. Pay attention to personal hygiene, change underwear frequently. Women should wipe from front to back with clean toilet paper after urinating.

　　4. Both partners should thoroughly clean the local area before and after sexual intercourse, and immediately empty the bladder of urine before and after sexual intercourse.

　　The diagnosis of bladder bleeding, in addition to looking for the cause, needs to be helped by urine tests, cystoscopy, and renal function index tests to help make a diagnosis. Once diagnosed, on the basis of actively eliminating the cause, hemostasis, removal of blood clots, cryoprecipitation, hyperbaric oxygen therapy, and comprehensive treatment such as electrocoagulation and chemical drug hemostasis should be given. For patients with severe and urgent conditions, surgery may be performed to remove blood clots, coagulate, and stop bleeding with chemical drugs.

　　Patients with bladder bleeding should drink more water and avoid eating foods that can worsen bleeding or irritate the bladder:

　　1. Eat more diuretic foods, such as watermelons, grapes, pineapples, celery, pears, etc.

　　2. Snails, corn, mung beans, and scallion whites can help alleviate symptoms such as frequent urination, urgency, and dysuria.

　　3. Increase fluid intake and maintain a daily urine output of at least 1500 milliliters or more.

　　4. Avoid eating sour and spicy foods, such as strong alcohol, chili, balsamic vinegar, sour fruits, etc.

　　5. Avoid eating citrus fruits, as they can cause alkaline urine, which is conducive to bacterial growth.

　　6. Caffeine can cause the bladder neck to contract and cause spasmodic pain in the bladder, so coffee should be drunk less.

　　Western treatment for bladder bleeding includes etiological treatment and symptomatic treatment, the first step should be to clarify the cause of bleeding, remove the cause, and give symptomatic treatment when necessary:

　　1. Immediately stop using or contacting drugs that can cause bladder bleeding.

　　2. Increase fluid intake and urinate frequently to reduce the concentration of metabolic products and the time of contact with the bladder.

　　3. Bladder medication lavage to reduce bleeding, such as the use of 1% silver nitrate solution, 1% alum solution, 4% or 10% formaldehyde solution, etc. The lavage fluid can be added with norepinephrine to help hemostasis.

　　4. Use systemic hemostatic drugs.

　　5. If there is bladder infection, antibiotics can be used to control the infection.

　　6. Supportive therapy: Blood transfusion and fluid replacement may be necessary for those with severe bleeding.

　　7. In cases of severe bleeding, bilateral internal iliac artery embolization or ligation may be considered.