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Blood in the urine (haematuria)

What is haematuria (also known as blood in the urine)?

Blood in the urine can either be visible, noted by the patient (urine may be pink, red, or dark brown), or non-visible (noted by a health professional on testing the urine either on a dipstick or a microscope). It can be classified as symptomatic (ie: causes the patient to have symptoms) or asymptomatic (does not cause any symptoms). Microscopic or dipstick haematuria is an incidental finding often discovered on urine tests as part of a routine medical evaluation, whereas gross haematuria should prompt the patient to visit his/her doctor. Haematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra.

What are the common causes of haematuria?

Blood in the urine is often not always a sign of a significant underlying problem. Studies have shown that between five and 15 percent of normal individuals can have some degree of haematuria. However, haematuria can be a sign of a serious underlying problem requiring treatment. These include urinary tract infection, bladder cancer, kidney cancer, urinary stone disease and prostate cancer. Ultimately about 1 in 5 patients with visible blood in the urine and about 1 in 12 patients with non-visible blood may have cancer of the urinary tract. 

How is haematuria investigated?

Patients who present with significant haematuria need assessment by a urologist. Significant haematuria is defined as one episode of visible haematuria or symptomatic non-visible haematuria, or persistent asymptomatic non-visible haematuria (2 out of three dipsticks positive).

Ideally, such patients should be seen as soon as possible in a one-stop clinic where the first step is a careful history and physical examination. The urine may be tested to look for signs of infection or other abnormalities. If needed, it will then be sent off for a culture, to see if there are any bacteria in it. A urinary cytology is also obtained to look for abnormal cells in the urine. A blood test may also be done to measure kidney function, and in men, after counselling, a PSA test may be performed.

Further tests include an ultrasound of the kidneys and bladder, or a CT scan of the abdomen and pelvis . A CT scan is the preferred method of evaluating kidney masses and is the best modality for the evaluation of urinary stones.

A flexible cystoscopy is also likely to be required. This is a look into the bladder with a small flexible telescope, which is inserted via the urethra under local anaesthetic. Looking through the cystoscope your urologist can examine the inner lining of the bladder and urethra for abnormalities.

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