What Is It?
Blood in the urine is either gross hematuria (seen by the individual during urination) or microscopic hematuria (noted on a laboratory test).
Symptoms of Hematuria
Hematuria is usually described as “painless” or “painful” which helps clinicians determine the likely cause. Hematuria can be associated with other urinary symptoms such as urinary frequency, urgency and dysuria. Hematuria may be present without symptoms and may be the only sign of significant underlying disease.
Common urologic causes of hematuria include urinary tract infections, kidney or bladder stones, benign prostate enlargement (BPH) and prostate infections. More serious causes of hematuria include bladder or kidney cancer.
Symptoms such as flank pain, urinary frequency, or painful urination (dysuria) may coexist with hematuria which aide in making the correct diagnosis.
In young children, microscopic hematuria is usually self-limiting. However, it is important that children with persistent/recurrent hematuria be evaluated by a urologist.
Evaluation and Treatment
When hematuria is unexplained or recurrent, it is important that a thorough and complete evaluation be done to rule out significant underlying disease such as urologic cancer (prostate, bladder, or kidney cancer).
The typical evaluation for hematuria includes a CT urogram (also referred to as a CT-IVP) as well as cystoscopy (a small camera is passed into the bladder to visually inspect the entire surface). Both of these tests are performed in the urologist’s office.
Other radiographic tests such as ultrasound and MRI are used occasionally depending on the clinical scenario of the individual.
Once a cause for the hematuria is identified, treatment ensues. When no cause for the hematuria is identified (“negative work-up”), referral to a nephrologist (physician whom specializes in medical diseases of the kidney) may be recommended.