Click the links below to access: Hematuria Video Series
What is Hematuria?
The presence of a high number of red blood cells (RBCs) in the urine. There are 2 main types of hematuria: microscopic and "gross" hematuria.
In microscopic hematuria, the urine appears normal to the naked eye. However, under examination with a microscope, the urine has a high number of RBCs. Microscopic hematuria is usually discovered through a urine test, as part of a medical evaluation.
In gross hematuria, the urine is pink, red or dark like the color of cola. There may be clumps or blood clots with gross hematuria.
Where does the blood in the urine come from?
The blood can originate anywhere along the urinary tract including the kidneys, ureters, bladder, urethra, and the prostate (in men).
What are the causes of Hematuria?
In many people, no specific cause is found. However, hematuria can be a sign of a serious medical condition. It should be evaluated by a urologist as soon as possible.
What are the common causes of Hematuria?
Common causes of hematuria include:
Cancer of Genitourinary Tract (Kidney, ureter, bladder, prostate)
Enlarged prostate (Benign Prostatic Hyperplasia)
Urinary Stones
Infection of Genitourinary Tract (Kidney, ureter, bladder, prostate)
Renal (kidney) Disease
Vigorous exercise or injury to the urinary tract
Bladder irritation from radiation or chemical exposure
How is Hematuria Diagnosed?
Gross hematuria is in most cases alarming to the patient and prompts them to seek early evaluation.
Microhematuria often has no symptoms, but can be caused by a serious medical condition.
Microhematuria is usually detected by a urine dipstick test. A positive dipstick test for hematuria needs to be confirmed by examination of the urine under a microscope. If there are 3 or more RBCs per high power field, an evaluation for the cause of hematuria is recommended.
What are the tests needed to evaluate hematuria?
A history and examination by a physician.
A blood test to estimate function of the kidneys
Imaging Tests:
Computed Tomography of the kidneys, ureters, and bladder (CT Urogram) with or without intravenous contrast
Used to evaluate the lining of the bladder wall
Cystoscopy recommended
Cystoscopy: A procedure in which a physician inserts a thin scope through the urethra and into the bladder to examine its lining
Urine Cytology:
A urine test in which the doctor looks for the presence of tumor cells under a microscope. Maybe be helpful in certain patients.
For patients who cannot have a CT because of a kidney disease or allergy to contrast/non-contrast CT, magnetic resonance imaging (MRI) or ultrasound in combination with retrograde pyelograms may be done.
What are the treatments for Hematuria?
The type of treatment depends on the cause of the hematuria.
What follow up tests are needed if no causes of Hematuria are found?
Your physician may consider repeating the test after some period of time, especially if you are at an increased risk of bladder cancer.
(Ex: over the age of 50, a current or former cigarette smoker exposed to chemical or radiation, as well as overuse of pain medication. If there is recurrent gross hematuria, one should immediately have a repeat cystoscopy and imaging done.
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