Haematuria

haematuria (blood in the urine)

Haematuria, the presence of blood in the urine, manifests in two distinct types. Microscopic haematuria, not visible to the naked eye, can be detected through urine testing. Conversely, macroscopic haematuria involves visible blood, resulting in urine discoloration in shades of pink, red, brownish-red, or tea-colored. The term "gross haematuria" is synonymous with visible blood in the urine.

underlying causes of haematuria

facts about haematuria

The most prevalent cause of blood in the urine is infection, notably cystitis.

  • Any confirmed presence of blood in the urine, whether visible or detected through a urine test, should undergo thorough investigation.

  • About 1 in 5 adults with noticeable blood in the urine and 1 in 12 adults with non-visible blood in the urine are subsequently diagnosed with bladder cancer.

  • In children, blood in the urine is seldom linked to cancer; more commonly, it indicates bladder infection or kidney inflammation (nephritis).

  • A single discovery of a minimal trace of blood during routine urine testing may not necessarily be significant.

  • Certain medications (e.g., rifampicin, nitrofurantoin) and dietary items (e.g., beetroot) can impart a reddish color to the urine.

Visible haematuria always requires complete assessment

Many causes of haematuria are benign

Common causes

Haematuria may originate from any part of the urinary tract, including the kidneys, ureters, bladder, prostate, or urethra.Common causes inldie but not limited to

  • Bladder infection

  • Cancers affecting the bladder, kidney, or prostate (pictured)

  • Enlarged prostate

  • Stones in the kidneys or bladder

  • Inflammation of the kidneys (nephritis)

  • Urinary tract injuries

  • Bladder changes due to previous radiation to prostate or pelvis

  • Blood disorders (e.g., sickle cell disease, clotting disorders, anticoagulant and anti-platelet drugs)

  • Other causes, including less common infections (e.g., TB, schistosomiasis)

Haematuria may originate from any part of the urinary tract

Kidney stones causing haematuria are often associated with pain

What happens after referral

If certain conditions are met, your GP will arrange an urgent referral to your local urology unit:

  1. Individuals aged 45 or above with visible blood in the urine without infection

  2. Failure of blood clearance post-antibiotic treatment for urinary infection

  3. Non-visible bleeding coupled with significant urinary symptoms

  4. Non-visible bleeding and individuals aged 60 or above with a high white blood count or discomfort during urination

After receiving your referral, our practice nurse will triage your case, and you'll be promptly contacted for a brief overview of your condition. Preceding your visit, several diagnostic tests, including PSA, urine analysis, urine cytology ultrasound, CT urogram, are arranged to enhance the evaluation. At your appointment, A/Prof Homi Zargar will engage with you, conduct a thorough assessment, and review the gathered information. A personalized care plan addressing your symptoms will be devised, ensuring all your questions are addressed. Further assessment may include the following:

  • Detailed inquiry about your urinary tract and related symptoms

  • Physical examination, which may include rectal or vaginal examination

  • Blood tests if not previously conducted by your GP

  • Urine examination for cancer cells

  • Imaging studies, such as a CT scan (may involve an iodine-based injection), ultrasound scan, and intravenous urogram (IVU - may involve an iodine-based injection, and allergy history is considered).

  • Flexible cystoscopy