HEMATURIA

Hematuria (bloody urine) is a common sign and symptom that may be encountered by any person regardless of age (Table 1). It is a danger signal that cannot be ignored. The passage of blood-stained urine may be the first sign of serious disease in the urinary tract, and a single episode of hematuria warrants urologic investigation. (Table 1)

Classification of Hematuria
It is helpful to classify hematuria in two ways: first by quantity and second by the time of its appearance during voiding. Gross hematuria is evident to the naked eye and microscopic is demonstrable under the microscope. The degree of hematuria (micoscopic vs gross hematuria) does not correlate with seriousiness of the disease (i.e. tumor).

Blood noted at the beginning of urination is called initial hematuria, and indicates disease in the urethra (i.e. stricture or urethritis). Terminal hematuria usually indicates disease of the prostate (in men) and bladder. Total hematuria indicates disease in the bladder, ureters, or kidneys. When blood is noted only between voiding or as stains on underwear, disease is at the urethral meatus or anterior urethra (shaft). Hematuria can be associate with or without pain.

Causes of Hematuria
The most common causes of hematuria are infection, stones, and tumors. However, the are a number of less common causes: enlarged prostate, trauma, renal infarction, renal vein thrombosis, sickle cell disease, exercise-related (jogging), bleeding disorders and inflammatory dieseases. Occasionally no cause can be identified, a condition known as idiopathic hematuria.

Evaluation
Your doctor will ask questions about your medical history and medication as well as perform a physical examination.

Lab Tests
A sample urine is obtain to confirm that blood is present (urinalysis). A urine culture checks for infections by growing bacteria on a culture plate. Urine can also be examined under a microscope for tumor cells (cytology). Blood test may also be performed.

Cystoscopy
Using a special telescope - like instrument call a cystoscope, your doctor can visualize problems in urethra, prostate and bladder. The procedure may be done in the office or at a hospital using local anesthesia, Sterile fluid expands the bladder and makes it easier to examine.

Intravenous Pyelogram
Intravenous pyelogram (IVP) is a series of x-rays of your urinary tract. The procedure, which is usually done in the hospital or a radiology clinic, can help detect stones, tumors, blockages, and other problems in the urinary tract. During the test, a special contrast solution is injected into your arm. The solution flows to your urinary tract allowing the kidneys, ureters, and bladder to be seen.

Other Tests
Depending upon your evaluation and diagnosis, other imaging tests may be necessary. An ultrasound is an image of the urinary tract created by sound waves. A computer tomography (CT or CAT) scan is a series of x-ray images that show a cross section of the urinary tract.

Treatment
Once the cause of your hematuria has been determined, you and your doctor can plan a treatment, if any is needed. Treatment can vary from medication, radiation or surgery.

Conclusion
Blood in the urine is a warning sign, don’t ignore it. See your doctor for an evaluation to help find it’s cause.