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Lewis Liew Urology

BLOOD IN URINE (HAEMATURIA)

What is blood in urine (haematuria)?

Haematuria means blood in the urine. Microscopic hematuria indicates that the blood is only seen when the urine is examined under a microscope, while gross (or macroscopic) hematuria means that there is enough blood in the urine so that it can be seen with the naked eye. Despite the quantity of blood in the urine being different, the types of diagnoses that can cause the problem are the same, and the workup or evaluation that is needed is identical.

Since blood in the urine must come from one of the organs involved in making or transporting the urine, the evaluation of hematuria requires that we consider the entire urinary tract. This organ system includes the kidneys, ureters (the tubes that carry the urine from the kidneys to the bladder), bladder, prostate, and urethra (the tube transporting urine out of the bladder). It must be emphasized that even a single episode of hematuria requires evaluation, even if it resolves spontaneously.

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Common Causes

There are multiple causes of blood in urine. Some are serious, including cancers, trauma, stones, infections, and obstructions of the urinary tract. Others are less important and may require no treatment. These may include viral infections, nonspecific inflammations of the kidney, medications which thin the blood's clotting ability, and benign prostate enlargement.

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Diagnosis

The evaluation for blood in urine consists of taking a history, performing a physical examination, evaluating the urine under a microscope, and obtaining a culture of the urine. A significant history would include whether or not there was any pain or discomfort associated with the hematuria, whether the blood was present in the beginning, end, or throughout the urinary stream, and finally, whether there is a personal history of smoking, kidney stones, injuries to the urinary tract, trouble urinating, or previous urologic evaluation.

No matter how obvious the reason for hematuria appears to be, a complete evaluation is almost always necessary to rule out a serious underlying disease, such as a cancer. There are usually three diagnostic tests necessary to give us a look at the entire urinary tract, and these include a computed tomography (CT) scan of the abdomen and pelvis, cystoscopy and a urine cytology.

The CT scan is an imaging evaluation of the urinary tract. Prior to the procedure, the patient drinks an oral contrast agent, and a dye is injected intravenously. The patient then goes through the CT scan machine and images are taken of the abdomen and pelvis. Another test that can be performed, the intravenous pyelogram (IVP), is also a type of X-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of X-rays are then taken over a 30-minute period, looking for abnormalities. The CT scan is more commonly performed than the IVP to evaluate the urinary tract and should be considered the test of choice. Both of these studies are especially useful for evaluating the kidneys and ureters but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. In this procedure, a cystoscope (thin fiberoptic camera) is used to visually inspect the bladder and the urethra. In most instances, this can be done without discomfort by the use of local anaesthetic jelly. The cystoscope is passed up the urethra into the bladder, and the inspection is carried out. The entire examination takes less than 10 minutes. The final test is a urine cytology, which involves voiding urine into a cup and having that urine examined by a pathologist to look for cancer cells.

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Treatment

Management of blood in urine depends upon the underlying cause. Many times, a cause cannot be found, which is fortunate, because it generally suggests that there is not a harmful situation present. Remember that the real reason for a haematuria workup is not to prove a specific cause but to rule out a serious problem. If no cause is found for the haematuria, the urine should be checked on a yearly basis to make certain that no changes are occurring. A blood test to check kidney function and a blood-pressure check should be done as well. Men over 50 should have a yearly prostate-specific antigen (PSA) blood test to screen for prostate cancer. However, if gross haematuria were to recur, repeat evaluation may be necessary

Further discussion of the treatment for haematuria would depend upon the results of the previously mentioned workup and the exact cause for the haematuria.

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