Hematuria

What is hematuria?

Hematuria is presence of red blood cells in the urine. There are many reasons why a person can have blood in their urine. This condition can be an indication of a serious problem or conversely, be a benign or non-threatening finding.

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?

It can be characterized as either “gross” (visible to the naked eye) or “microscopic” (visible only under the microscope).

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?

Any patient with gross hematuria or significant microscopic hematuria should have further evaluation ofthe urinary tract. The first step is a careful history and physical examination. Other testing includes:

• 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.

Treatment

Treatment for blood in the urine depends on the cause and source of the blood. For less complex causes such as kidney stones or infection, management involves simply treating the condition. Kidney stones may be treated by observation, medications, and surgery. Simple urinary tract infections are treated with antibiotics. In more complex causes such as bladder or kidney cancer, the blood in the urine is an indication of a larger problem that needs to be properly addressed.

What if no abnormality is found?

• In at least 8-10 % of cases, no cause for hematuria is found. Unfortunately, studies have shown 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.