from the urinary tract. removing all blood clots prevents the formation of this natural anticoagulant. this in turns facilitates the cessation of bleeding from the urinary tract. the acute management of obstructing clots is the placement of a large (22–24 french) urethral foley catheter. clots are evacuated with a toomey syringe and saline irrigation. if this does not control the bleeding, management should escalate to continuous bladder irrigation (cbi) via a three-port urethral catheter. if both a large urethral foley catheter and cbi fail, an urgent cystoscopy in the operating room will be necessary. lastly, a transfusion and/or a correction of a coexisting coagulopathy may be necessary. medical emergency: urosepsis urosepsis is defined as sepsis caused by a urogenital tract infection and comprises about 25% of all sepsis cases. urosepsis is the result of a systemic inflammatory response to infection and can be identified by numerous signs and symptoms (e.g. fever, hypothermia, tachycardia, and leukocytosis). signs and symptoms that indicate a urogential tract infection is the source of the sepsis may include, but are not limited to, flank pain, costovertebral angle tenderness, pain with micturition, urinary retention, and scrotal pain. in terms of the visibility, hematuria can be visible to the naked eye (termed "gross hematuria") and may appear red or brown (sometimes referred to as tea-colored), or it can be microscopic (i.e. not visible to the eye but detected of urosepsis. in addition to imaging tests, patients may be treated with antibiotics to relieve the infection and intravenous fluids to maintain cardiovascular and renal perfusion. acute management of hemodynamic status, in the event intravenous fluids are unsuccessful, may include the use of vasopressor medications and the placement of a central venous line. epidemiology in the united states, microscopic hematuria has a prevalence of somewhere between 2% and 31%. higher rates exist in individuals older than 60 years of age and those with a current or prior history of smoking. only a fraction of individuals with microhematuria are diagnosed with a urologic cancer. when asymptomatic populations are screened with dipstick and/or microscopy medical testing about 2% to 3% of those with hematuria have a urologic malignancy. routine screening is not recommended. individuals with risk factors who undergo repeated testing have higher rates of urologic malignancies. these risks factors include age (> 35 years), male gender, previous or current smoking, chemical exposure (e.g., benzenes or aromatic amines), and prior pelvic radiation therapy. in pediatric populations, the prevalence is 0.5–2%. risks factor include older age and female gender. about 5% of individuals with microscopic hematuria receive a cancer diagnosis. 40% of individuals with macroscopic hematuria (blood easily visible in the urine) receive a cancer diagnosis.