Blood In Urine
(Hematuria)
What is hematuria?
Hematuria means blood in the urine. Microscopic hematuria indicates that the blood is only seen when the urine is examined under a microscope, while gross hematuria means that there is enough blood in the urine so that it can be seen with the naked eye. Despite the quantity of blood in the urine being different, the types of diagnoses that can cause the problem are the same, and the workup or evaluation that is needed is identical.
Since blood in the urine must come from one of the organs involved in making or transporting the urine, the evaluation of hematuria requires that we consider the entire urinary tract. This organ system includes the kidneys, ureter (the tube that carries the urine from the kidney to the bladder), bladder, prostate, or urethra (tube leading out of the bladder). It must be emphasized that even a single episode of hematuria requires evaluation, even if it resolves spontaneously. 
What are the causes of hematuria?
There are multiple causes of hematuria. Some are serious, including cancers, trauma, stones, infections, and obstructions of the urinary tract. Others are less important, and may require no treatment. These may include viral infections, nonspecific inflammations of the kidney, medications which thin the blood's clotting ability, and benign prostate enlargement.
How is hematuria evaluated?
The evaluation for hematuria consists of taking a history, performing a physical examination, evaluating the urine under a microscope, and finally, obtaining a culture of the urine. A significant history would include whether or not there was any pain or discomfort associated with the hematuria; whether the blood was in the beginning, end, or throughout the urinary stream; and finally, whether there is a personal history of smoking, kidney stones, injuries to the urinary tract, trouble urinating, or previous urologic evaluation.
No matter how obvious the reason for hematuria appears to be, a complete evaluation is almost always necessary to rule out a serious underlying disease, such as a cancer . There are usually three diagnostic tests necessary to give us a look at the entire urinary tract, and these include the intravenous pyelogram (IVP), cystoscopy, and a urine cytology.
The intravenous pyelogram, or IVP, is an x-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of x-rays are then taken over a thirty-minute period, looking for abnormalities. This study is especially useful for evaluating the kidneys and ureter, but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. In this procedure, a small viewing tube, or cystoscope, is used to visually inspect the bladder and the urethra. In most instances, this can be done without discomfort by the use of local anesthetic jelly. The cystoscope is passed up the urethra into the bladder, and the inspection is carried out. The entire examination takes less than ten minutes. The final test is a urine cytology, which involves voiding urine into a cup and having that urine examined by a pathologist to look for cancer cells.
How is hematuria treated?
Management of hematuria depends upon the underlying cause. Many times a cause cannot be found, which is fortunate, because it generally suggests that there is not a harmful situation present. Remember that the real reason for a hematuria workup is not to prove a specific cause, but to rule out a serious problem. If no cause is found for the hematuria, the urine should be checked on a yearly basis to make certain that no changes are occurring. However, if gross hematuria were to recur, repeat evaluation may be necessary, and a physician should be consulted. A blood test to check kidney function and a blood pressure check should be done as well. Men over fifty should have a yearly PSA, or prostate specific antigen, to screen for prostate cancer .
Further discussion of the treatment for hematuria would depend upon the results of the previously mentioned workup and the exact cause for the hematuria. The urologist who performs this examination would direct any further treatment or workup that would be necessary. - Blood in urine can sometimes be visible only with a microscopic.
- Evaluating blood in urine requires consideration of the entire urinary tract.
- Tests used for the diagnosis of blood in urine include the intravenous pyelogram (IVP), cystoscopy, and urine cytology.
- Management of blood in urine depends upon the underlying cause.
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