Persistent Hematuria: When to Consider Cystoscopy - Urology

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Persistent hematuria, or the presence of blood in the urine, can be a concerning symptom that warrants further investigation. In your case, it’s important to understand the potential causes of hematuria and when a cystoscopy might be necessary.

Hematuria can be classified into two types: gross hematuria, where blood is visible to the naked eye, and microscopic hematuria, where blood is only detectable under a microscope. Since you mentioned having persistent microscopic hematuria, it is essential to consider various factors that could contribute to this condition.

Common causes of hematuria include urinary tract infections (UTIs), kidney stones, trauma, benign prostatic hyperplasia (in men), and malignancies of the urinary tract, including bladder cancer. In your case, since you have a history of proteinuria and persistent hematuria, it is crucial to rule out any underlying renal or urinary tract pathology.

You have undergone several diagnostic tests, including ultrasound and X-rays, which have returned normal results. However, these imaging studies may not always provide a complete picture, especially for conditions affecting the bladder or urethra. This is where cystoscopy becomes a valuable diagnostic tool. Cystoscopy involves the insertion of a thin, flexible tube with a camera (cystoscope) into the bladder through the urethra, allowing direct visualization of the bladder lining and urethra. This procedure can help identify abnormalities such as tumors, stones, or inflammation that may not be visible on imaging studies.

Given your history of persistent hematuria and the fact that you have already ruled out some common causes, it may be prudent to consider cystoscopy. The American Urological Association recommends cystoscopy for patients with persistent hematuria, especially if they are over 35 years old or have risk factors for bladder cancer, such as smoking or a history of chemical exposure.

In your case, since you have had hematuria since childhood and have experienced a change in your urinary symptoms, a cystoscopy could provide clarity on the underlying cause of your persistent hematuria. It is also worth noting that while some cases of hematuria may resolve spontaneously or be benign, persistent hematuria should not be ignored, as it can sometimes indicate more serious conditions.

In conclusion, while your previous tests have returned normal results, the persistence of hematuria, especially in the absence of a clear diagnosis, suggests that further evaluation is warranted. A cystoscopy could be a valuable next step in your diagnostic journey, allowing for a more thorough investigation of your urinary tract and potentially identifying any underlying issues that need to be addressed. It is advisable to discuss this option with your healthcare provider, who can help you weigh the benefits and risks of the procedure based on your specific situation.