Final answer:
Further management after cystoscopy in a high-risk patient with hematuria includes a urine culture to exclude infection, microscopic examination of urine, and possibly imaging of the kidneys. Treatment may consist of antibiotics if an infection is present, and further analysis of any retrieved stones.
Step-by-step explanation:
After a cystoscopy evaluation for hematuria in a high-risk patient, the next steps in management usually involve further diagnostic tests to pinpoint the exact cause of the bleeding. These include:
- A culture of a urine sample to exclude any urinary infection that might cause the hematuria, or be a secondary result due to another condition like stones.
- Microscopic examination of urine, which may show proteins, red blood cells, pus cells, bacteria, cellular casts, and crystals indicating different types of urinary conditions.
- Imaging of the kidneys, especially in patients with risk factors like diabetes, immunosuppression, prior renal damage, or suspected obstruction. This could include a CT scan, ultrasonography, or an MRI.
For treatment, the doctor's recommendations will be tailored based on the underlying cause revealed by these tests. If an infection such as pyelonephritis is diagnosed, then treatment would likely include oral or intravenous antibiotics such as penicillins, cephalosporins, or fluoroquinolones. If a stone is causing obstruction or infection, then strategies to retrieve and analyse the stone could also be considered.