Hematuria is the presence of blood in the urine. It can be microhematuria (when the blood is not seen but is noticed on laboratory analysis such as urinalysis) or it can be gross hematuria (when the blood is seen while urinating).
Blood in the urine may be caused by a simple problem such as a urinary infection or benign inflammation, but can sometimes be caused by more serious conditions such as kidney or bladder cancer or kidney stones, so you should always report the blood in the urine to your primary doctor or to your urologist.
Causes of blood in the urine (hematuria) are varied – a partial list includes kidney stones, kidney tumors, tumors in the ureter (the tube that connects the kidney to the bladder), stones in the ureter, bladder or kidney infections, bladder tumors, urethral strictures or urinary infections.
The evaluation typically begins with a urinalysis and culture to determine if a urinary infection is present. If no infection is present then imaging of the kidneys and the ureters should be considered. We believe the best imaging is a CT scan of the abdomen and pelvis with and without intravenous contrast. In addition to this, the third component of the workup is cystoscopy which is inspection of the urethra and the bladder with a fiber optic scope. The cystoscopy is normally done in the office under local anesthesia and is used to diagnose bladder and urethral problems. Additionally either before or during the cystoscopy a urine may be sent out for a special test called cytology to determine if any abnormal cells are seen with microscopic examination.
For the patients who smoke cigarettes, the risks of bladder cancer and kidney cancer are higher, so workup of the hematuria is particularly important. In the younger patients, who are nonsmokers who do not have gross hematuria but only asymptomatic microscopic hematuria, occasionally these patients can be monitored without needing to undergo invasive testing.
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