Haematuria means blood in urine. It must be taken seriously as it can indicate cancer; especially bladder cancer. If you notice blood in the urine it should always be investigated.
Haematuria is usually divided into macroscopic (where the urine is discoloured) and microscopic (where the blood is found only on dipstick or microscopy examination).
Patients on anticoagulants who have haematuria must be fully investigated as below, since haematuria is not a normal consequence of anticoagulation.
Investigations for Haematuria
General Physical Examination - This includes blood pressure, pulse, and examination of prostate in a male and the gynaecological organs in a female.
Urine tests - A mid-stream specimen of urine for microscopy of red and white blood cells, and bacteria. Three sets of urine tests looking for cancer cells in the urine (cytology) will also be performed.
Blood tests - All patients should have a full blood count, serum urea, creatinine and electrolytes should be measured, along with albumin, calcium and liver function tests.
CT Scan - A CT scan will be performed to look at the kidneys, the ureters (the tubes that drain the urine from the kidneys to the bladder), and the bladder. Contrast iodine-based dye will be given for this wherever possible. If the kidneys are not working properly then dye may not be given.
Cystoscopy - A telescopic examination of the bladder is always required. Even if the scans have not shown anything, they can miss bladder cancers. The best way to look at the bladder is by inserting a telescope into the bladder through the penis in a male, or through the urinary opening in a female. Cystoscopies can be performed under general anaesthetic or under local anaesthetic with a smaller, flexible telescope.
Causes of Haematuria
The tests will aim to look for the cause of the bleeding. There are several possible causes including:
- Bladder cancer
- Kidney cancers
- Benign prostate enlargement
- Prostate cancer
- Inflammatory and other conditions of the kidney itself such as glomerulonephritis
- Other rare conditions
Treatment is directed at the underlying cause. If a badder tumour is found, it will be removed at the time of the cystoscopy. It's like removing a bowel polyp during a colonoscopy. However if a bladder tumour is removed, then the patient may need to stay in hospital for a day or two with a catheter in the bladder to help the bladder drain. Most (70%) of bladder cancers are superficial at presentation and are managed by transurethral surgery with or without the use of intravesical therapy. For invasive tumours the choice lies between radical cystectomy (removal of the entire bladder) or radiotherapy. Metastatic disease may respond to chemotherapy.