What is Haematuria?

Haematuria is the presence of blood in the urine.  It may be visible or invisible (microscopic) – this type is usually picked up on dipping the urine with a dipstick.  It is associated with many different causes depending on where it is coming from but its presence requires investigation as it may potentially be serious.

What are the symptoms of Haematuria?

  • You may pass blood in the urine that is painless, as a single episode or ongoing bleeding.
  • You may pass blood in the urine associated with a temperature, loin or lower abdominal pain, or when you pass urine.
  • You may pass blood in the urine associated with other medical conditions, including shortness of breath, abdominal pain, or blood-thinning medicines such as Warfarin.
  • You may find that you also pass dark gelatinous clots of blood in the urine. IF THIS STOPS YOU PASSING URINE, YOU SHOULD CALL YOUR UROLOGIST OR VISIT CASUALTY.

What causes Haematuria?

The commonest causes of blood in the urine range from urinary tract infections and cystitis, through to stone disease and kidney disease.  Both medical and surgical conditions that lie near to the urinary tract can also cause bleeding on occasion, as can some medication.  Certain types of cancer can also cause this sign, so the blood in the urine is a symptom that should not be ignored, and should be properly investigated as an urgent priority.

How are the causes diagnosed and what are the treatments?

Everybody who presents to a urologist with blood in the urine will have a full history is taken and a thorough examination.  This will include an internal examination in most cases.  Urine tests will be sent to check for infection and for abnormal cells.  Blood tests will also be sent to help exclude the medical causes of blood in the urine.  If you are on Warfarin, your urologist will send an INR (International Normalised Ratio) blood test to see that your blood thinness is in the correct range for your condition.

All patients with visible blood in the urine will be offered a visual inspection of the bladder using a camera (cystoscopy).  This can be done with you asleep or awake and local anaesthetic jelly is used to numb the water pipe (urethra).  Patients will usually undergo a scan, either an ultrasound or CT scan, based on how well your kidneys are functioning.

Many patients with microscopic bleeding will also be offered a cystoscopy, especially if you smoke, and an ultrasound of the kidneys.

What are the surgical procedures available?

This depends upon what is found:

  • Haematuria clinic work-up package – urine tests, blood tests, cystoscopy and scan of the kidneys.
  • If a bladder cancer is suspected, a general anaesthetic inspection to remove this, called a TURBT, will be performed.
  • If prostate cancer is suspected, a biopsy of the prostate will be performed.
  • If kidney cancer is suspected, partial or complete kidney removal may be offered.
  • If a stone is discovered, removal using a telescope, sound waves or keyhole surgery will be offered.

Infections remain the commonest cause of blood in the urine, but as cancerous causes are possible, their exclusion is absolutely vital.  The author cannot recommend highly enough, early presentation to a urological surgeon for rapid screening and treatment of the cause.

Author: Mr Stuart Graham BSc MBBS FRCSEd FRCS(Urol)

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