Painless Hematuria: When to Consult a Urologist

Q: Painless Hematuria: When to Consult a Urologist

Hello： 1. <br>Should I go to a urologist or gynecologist for a detailed examination to rule out potentially more serious issues since there is no pain associated with the hematuria? --> If there is no visible hematuria, observation is acceptable. <br>The first test, OB2+, with no

Please help me ask questions regarding painless hematuria for my mother?

A 65-year-old female underwent lumbar spine surgery six months ago (in May 2021).
Prior to the surgery, her urinalysis showed a positive result for occult blood (OB: 2+), while other values such as RBC and WBC were negative, which should be considered as sediment examination.
The attending physician stated that all pre-operative data were normal.
Recently, during a follow-up visit to a metabolic clinic for monitoring hypertension and thyroid issues in November 2021, she had another urinalysis that showed some abnormal results (though she reported no symptoms).
The results indicated: 1.
Cloudy urine 2.
OB: 2+ 3.
RBC: 10-19 4.
WBC: 6-9 5.
Lipase in white blood cells: 2+ 6.
Other - Urine: Mucous, with all other results being negative.

She regularly undergoes abdominal ultrasounds to monitor liver cysts and has a 0.3 cm kidney stone that has been present for over two years.
She has been taking natto and red yeast rice to manage her slightly elevated cholesterol levels.
The clinic physician advised her to drink more water and stated that no follow-up was necessary since there were no symptoms.

1.
Given the presence of painless hematuria, should she consult a urologist or gynecologist for further evaluation to rule out more serious issues? Would tests such as a bladder ultrasound, abdominal X-ray, cystoscopy, MRI, or CT scan be appropriate? Under the national health insurance system, would doctors agree to perform these tests?
2.
Can these results definitively indicate a urinary tract infection?
3.
How long should she wait before returning to the hospital for re-evaluation and follow-up testing? The last urinalysis was on November 15, and her urine was reported to be slightly yellow during the testing period, but returned to normal two days later.

Mr. Chen, 30~39 year old female. Ask Date: 2021/11/23

Dr. Du Shixi reply Urology

Hello: 1.
Should I go to a urologist or gynecologist for a detailed examination to rule out potentially more serious issues since there is no pain associated with the hematuria? --> If there is no visible hematuria, observation is acceptable.
The first test, OB2+, with no RBCs, should be considered normal, such as bladder ultrasound, abdominal X-ray, cystoscopy, MRI, or CT.
Will doctors agree to perform these tests under the national health insurance system? --> Generally, they will likely conduct a urine test to see if further investigation is needed.
2.
Do these results confirm a urinary tract infection? --> The urine test at the clinic is likely to indicate a higher chance of infection; however, contamination can occur if the midstream urine is not collected properly.
3.
How long should I wait before going back to the hospital for re-examination? The last test was on 11/15 (my mother mentioned that the urine appeared slightly yellow during the testing period, but returned to normal two days later).
--> Drink plenty of water; there is no specific interval required for urine testing, but it is important to collect midstream urine.
Wishing you good health.

Reply Date: 2021/11/23

More Info

When it comes to painless hematuria, particularly in a 65-year-old woman with a history of urinary findings, it is essential to approach the situation with caution and thoroughness. Hematuria, or the presence of blood in the urine, can be indicative of various underlying conditions, some of which may require prompt medical attention. Here’s a detailed response to your questions:
1. Consulting a Urologist: Given that your mother has experienced hematuria with no accompanying pain, it is advisable to consult a urologist. While the absence of pain might suggest a less urgent issue, it does not rule out serious conditions such as bladder cancer, kidney stones, or urinary tract infections (UTIs). The presence of blood, even without pain, warrants further investigation. A urologist can perform a comprehensive evaluation, including a physical examination and a review of her medical history.

Diagnostic tests that may be considered include:
- Urinalysis: This can help identify the presence of red blood cells, white blood cells, and other abnormalities.

- Ultrasound: A bladder ultrasound can help visualize any structural abnormalities in the urinary tract.

- CT Scan or MRI: These imaging techniques can provide detailed images of the kidneys and bladder, helping to identify stones, tumors, or other issues.

- Cystoscopy: This procedure allows direct visualization of the bladder and urethra, which can be crucial for diagnosing bladder conditions.

Under the healthcare system, a urologist would typically agree to perform these tests if there are indications of potential issues based on the patient's symptoms and history.

2. Determining the Cause of Hematuria: The lab results you provided indicate the presence of blood (RBCs) and the presence of occult blood (OB: 2+), which could suggest a urinary tract infection or other conditions. However, the presence of RBCs alone does not confirm a UTI, especially if there are no symptoms such as pain, burning during urination, or frequent urination. It is essential to consider other potential causes, including:
- Kidney stones: Even small stones can cause bleeding.

- Bladder or kidney tumors: These can present with painless hematuria.

- Glomerular disease: Conditions affecting the kidneys can lead to blood in the urine.

3. Follow-Up and Timing for Re-evaluation: It is generally advisable to follow up with a healthcare provider within a few weeks after abnormal findings, especially if there are changes in symptoms or if new symptoms develop. Since your mother has had a history of kidney stones and other urinary findings, it would be prudent to schedule a follow-up appointment with the urologist soon. If she experiences any new symptoms, such as pain, changes in urination patterns, or any other concerning signs, she should seek medical attention immediately.

In summary, while the absence of pain might lead some to dismiss the findings, the presence of blood in the urine is significant and should not be overlooked. A thorough evaluation by a urologist, including appropriate imaging and possibly cystoscopy, is warranted to rule out serious conditions and ensure proper management. Regular follow-ups and monitoring of her condition will be crucial in addressing any potential issues early on.

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