Blood in the Urine (Hematuria)

Blood in the urine, or hematuria, is one of the most common conditions we see as urologists.  Each year every patient should have an annual urinalysis as part of their annual check-up with their primary care physician. A urine analysis is used to detect microscopic blood in the urine.  Abnormal urine analysis include patients who have >2 red blood cells per high power field.  Seeing blood in the urine, or gross hematuria is always abnormal.  Those patients who have either microscopic or gross hematuria warrant a full urologic evaluation.

Evaluation for blood in the urine is standard for most patients.  It consists of checking three separate tests.  These tests are designed to identify the causes of the hematuria. Identifiable causes of blood in the urine include bladder cancer, kidney cancer, ureteral cancer, prostate cancer, stone disease, inflammation, infection, prostatic enlargement, benign bladder or urethral polyps, medications, contaminated voided urine sample, trauma or strenuous exercise.  In some patients there will be no identifiable cause of the blood in the urine and these patients are thought to have “essential microhematuria”.

In addition to a comprehensive history taking and physical examination, three tests are performed on all patients with hematuria.

  1. Urine cytology or Pap urine.  A spun urine sample is carefully examined by a pathologist to look for abnormal appearing cells.
  2. Upper tract imaging.  It is essential to determine if the blood in the urine is coming from the kidneys or the ureters (narrow tubes that drain urine from the kidney to the bladder).  A variety of imaging tests can be ordered including a CT Scan with intravenous contrast, IVP (intravenous pyelogram), ultrasound or MRI with intravenous contrast.
  3. Cystoscopy.   A 5-10 minute simple procedure that uses a telescopic camera to inspect the inner lining of the bladder.