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Haematuria is the medical term given to the presence of blood in a patients urine. This can either be ‘macroscopic’, which can be seen by the patient or ‘microscopic’ which is only detectable using urine test sticks or when a urine sample is sent off for analysis.
The presence of blood in the urine could be a sign of an underlying problem and therefore should always be investigated. Should either you or your doctor detect the presence of blood in your urine then you should be seen initially by a urological surgeon.
Whilst a significant number of cases there will be nothing to worry about and no treatment required, in some cases the presence of blood could be as a result of conditions such as: infection, kidney or bladder stones, kidney, prostate, or bladder cancer.

 

Symptoms of Haematuria

Microscopic haematuria is most often associated with no symptoms and can easily be detected with the use of urine dipsticks. Whilst these tests do occasionally give a false positive result they are an excellent initial test for haematuria. If you are found to be positive for microscopic haematuria on a couple of occasions then your doctor should refer you on to a specialist (urologist).

Macroscopic haematuria is more obvious as the patient will see blood when passing urine. This is most often a bright red colour, but on some occasions old blood can look a dark brown or rusty colour. If you think you have seen blood in your urine then you should consult a doctor as soon as possible.

 

Common Causes of Haematuria

  1. Bladder cancer: more common men, smokers and risk increases with age
  2. Kidney cancer: more common in men, diabetics, family history, obesity and smokers
  3. Prostate cancer: only effects men, more common with family history and afro-caribbean ethnic groups, risk increases with age
  4. Kidney / Bladder stones: increased risk with poor fluid intake and some diets.
  5. Infection: often associated with symptoms such as pain on passing urine and increased frequency.
  6. Idiopathic: this is the term given to unknown cause, often despite a number of investigations the cause of haematuria will remain unknown. 

 

Patient Referrals

If you are referred to Manchester Urology then you will be seen throughout your investigations and possible treatment by an experienced senior consultant. 
Initially they will listen to your recent history and also take into account all your past medical history and any relevant risk factors. Following this they will perform an examination which will include a rectal examination in men (to enable them to assess your prostate). In some cases an internal examination is required in women, however this is often left until the time of a cystoscopy to limit the number of internal examinations.

Unless you have had recent blood tests then some baseline bloods are likely to be required. 

In order to determine where the bleeding was/is coming from then you will need two further investigations.

  1. CT scan or Ultra-sound scan. Both of these tests are primarily looking for abnormalities with you kidneys, they can however detect other conditions within your abdomen they may be unrelated to your original condition.
     
  2. Flexible cystoscopy. This is performed as an out-patient procedure with topical local anaesthetic and involves the passage of a small fibre-optic camera into your bladder via the urethra (the tube you pass urine through). The bladder is filled with sterile fluid to allow a full inspection of its lining. 

Once all of your investigations have been performed and the results are through then your consultant will explain everything to you. If any abnormality has been found then prompt and appropriate arrangements will be made to treat and hopefully resolve any underlying issues.

In the majority of cases no cause will be found and then you will either be reassured that no further action is required or further more tailored investigations carried out.

 

Information leaflets

Flexible cystoscopy (local anaesthetic) 
http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Cysto_flexible14.pdf

Rigid Cystoscopy (general anaesthetic)
http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Cysto_rigid.pdf

MU treatment and investigation specific information leaflets / consent forms

 

Links

NHS choices
http://www.nhs.uk/conditions/blood-in-urine/Pages/Introduction.aspx

British Association of Urology
http://www.baus.org.uk/patients/conditions/2/blood_in_the_urine_haematuria