Expert Health Articles

Hematuria

Nicholas Pottkotter, CNP

Certified Nurse Practitioner, Blanchard Valley Urology Associates

Why are health care providers concerned about checking for blood in the urine? Blood found in the urine may be an early warning sign of cancer. According to the American Cancer Society, bladder cancer is the fourth leading cause of cancer in men. Men are three to four times more likely to be diagnosed with bladder cancer than women. There are about 79,000 new bladder cancer diagnoses each year and about 17,000 deaths caused by bladder cancer. In almost half of the newly diagnosed bladder cancer patients, the cancer is confined to the inner layer of the bladder wall and has not spread to the surrounding area. Early detection is best for treatment results and best possible outcomes. The relative survival rate is 77% for five years, 70% for 10 years and 65% for 15 years.

Hematuria is simply blood found in the urine. This can be divided into two groups, gross hematuria and micro hematuria. Gross hematuria is blood that is visible in the urine with your eyes. This may be in the form of actual blood clots passing through the urethra to red/pink tinged urine. It only takes one small drop of blood to make toilet water pink. Micro hematuria is blood that is found in the urine that cannot be seen with your eyes but is found with testing. Such testing includes urine dip sticks that are commonly done in the office and urine microscopy in which red blood cells are seen using a microscope. Urine microscopy is the most sensitive. A diagnosis of micro hematuria should be made after a patient has two positive findings of three or more red blood cells on a urine microscopy four to six weeks apart.

Either finding of gross or micro hematuria needs further monitoring and investigation. Causes of blood in the urine may be from infection, kidneys stones, inflammation, strenuous exercise, menstruation, prostate, trauma, kidney disease or cancer to name a few. After adequate treatment for a presumptive cause for hematuria should be followed up with repeat testing to confirm that the hematuria has resolved. The best test for this would be urine microscopy as there can be false positives with urine dip sticks. If blood is still found in the urine after adequate treatment and healing from the presumptive cause further investigation is warranted to rule out more serious causes such as bladder cancer or renal (kidney) tumors.

Further testing may include an ultrasound of the kidneys and bladder, CT urogram (CT scan of the entire urological system), MRI, urine cytology (looking for precancerous or cancerous cells in the urine) or cystoscopy in which an urologist looks into the bladder with a special camera. During a cystoscopy the entire bladder is examined looking for any abnormality.

If you currently have hematuria, had it in the past or think you may have tested positive before and have not been fully evaluated, please contact your primary health care provider to discuss or ask for a referral to your local urologist.