Blood in the urine (hematuria) is one of the most common reasons a patient is sent to see a urologist and, for anyone who has ever had the experience of seeing blood in their urine, one of the most traumatic. Reassuringly, blood is a very strong pigment and it doesn’t take much blood to turn urine very red. With that in mind, I thought it would be helpful to talk a bit about why this is a potentially serious symptom and what I, as a urologist, do to evaluate it.
Blood in the urine is classified into two types based on whether it is visible to the naked eye (called gross hematuria) or only visible on microscopic evaluation (called microscopic hematuria). The questions I ask and the investigation that I do is aimed at learning where the blood is coming from so that it can be treated. It may be surprising that in many cases, no cause is ever found! And that is ok as the investigation that I do in this situation is designed to rule out anything serious.
Some of the causes of blood in the urine include: kidney stones (these can be otherwise completely asymptomatic), urinary tract infections, trauma, an enlarged prostate, or various urological cancers including cancers of the kidney, bladder, ureter or prostate.
The American Urological Association recommends that all patients with blood in the urine undergo two diagnostics tests. The first is a contrasted CT scan. The reason this is done is that the kidney and ureters (the pipe between the kidney and the bladder) is basically impossible to examine on physical exam. The second test is a brief visualization of the bladder itself. The reason this minimally invasive procedure is recommended is that because the bladder is a hollow organ, it is not well visualized on CT scan and small tumors are easily missed by CT scan.
Overall, while most people with blood in their urine are not found to have any significant urological problem, blood in the urine is the most common presenting symptom of most urological cancers so should be considered a serious medical issue and needs full and prompt investigation.
If you have any questions, please call my office at (719) 531-7007 to make an appointment!