Blood in the urine may be an alarming sight for most individuals. At the Austin Urology Institute, we perform a thorough work-up to see where the blood is coming from, and why it is there. Treatment and management is then based upon those findings.
What is hematuria?
What are the common causes of hematuria?
- Blood in the urine is often not a sign of significant disease. Studies have shown that between 9-18% of normal individuals can have some degree of hematuria, with no problems or diseases.
- Kidney stones
- Urinary tract infections (UTIs)
- Cystitis (inflammation of the bladder)
- Prostatitis (inflammation/infection of prostate)
- Prostate enlargement
- Bladder Cancer
- Kidney Cancer
- Injury to the kidneys, ureters, bladder, or prostate
- Prostate Cancer
- Extreme or prolonged exercise
How is hematuria diagnosed?
Microscopic hematuria may be discovered on urine tests as part of a routine medical evaluation, whereas gross hematuria that you can see, should prompt a visit to the doctor. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra.
What common tests are done?
- Urine analysis – a quick office procedure done by a dipstick test, which is able to detect blood.
- Urine culture – if there is an indication that there may be bacteria growing in the urine, this test will confirm and tell us specifically which bacteria is present.
- Imaging – imaging typically involves either an ultrasound or CT scan, which allows us to evaluate for kidney stones, masses, tumors, or other abnormalities that could be contributing to blood in the urine.
If these common tests come back negative, or we need further evaluation of the source of bleeding, we may perform additional procedures. These include:
- Urine cytology – looks for abnormal cells in the urine. This test is done in our office with a urine sample that you leave. Within 30 minutes the test will turn positive or negative for abnormal cells. If positive, we will do further testing to rule out diseases such as bladder cancer.
- Cystoscopy – involves a small camera advanced through the urethra into the bladder, to look for irregularities in the inner lining of the urethra and bladder. This is a short procedure done in our office, which takes 1-2 minutes to do on average. A topical analgesic is applied to the urethra before we begin. Since the camera is attached to a video screen, you can look along with us.
What if no abnormality is found?
- In at least 8-10 % of cases, no cause for hematuria is found. Unfortunately, studies haveshown that urologic malignancy is later discovered in 1-3% of patients with negative work-ups. Therefore, some form of follow-up is recommended.
- Consideration should be given to repeating the urine analysis and urine cytology every 6 months for 2-3 years. Immediate re-evaluation with possible cystoscopy and repeat imaging should be performed in the face of gross hematuria (visible blood in the urine), abnormal urine cytology, or irritating urinary symptoms such as pain with urination or increased frequency of urination. If none of these symptoms occur within three years, no further urologic testing is needed.