Hematuria: Causes, Diagnosis, and Next Steps for Patients

Hematuria

Hello Doctor, last month during a company health check, I was found to have hematuria.
I subsequently visited a urology clinic and underwent a renal ultrasound, which showed no issues.
Later, I had a bladder function test that indicated a possible problem with post-void residual urine.
The doctor seriously suspected I might have a benign urethral tumor.
I then went to Chang Gung Memorial Hospital for further examination, where I had a venography that revealed my right kidney was somewhat swollen.
The doctor concluded that I might have had kidney stones in the past, but since no stones were visible, he speculated that I had passed them on my own.
He also arranged for a cystoscopy, which only showed that my urine was somewhat cloudy, and there was no bleeding in the bladder or ureters.
He suggested that I might simply have cystitis, but I keep emphasizing that I do not feel any discomfort.
If I had stones or cystitis, wouldn’t I feel pain? In my company's health check report earlier this year, it only mentioned suspected urethritis and advised me to seek medical attention, so I thought it was a common condition for women and didn’t pay much attention to it.
However, I have been careful to drink plenty of water and avoid holding my urine.
Could you please advise if I need to undergo any further tests or if regular follow-ups are sufficient? Thank you.

myrna, 20~29 year old female. Ask Date: 2004/09/21

Dr. Weng Wenzhen reply Urology

First, confirm whether the urine examination during the physical check-up includes a microscopic examination of the urine sediment.
If the microscopic examination shows more than 5 red blood cells, it is considered hematuria; if it only shows a trace of blood, it does not necessarily indicate hematuria.
Since the examination at the medical center did not reveal any findings, you can simply follow up with regular check-ups.

Reply Date: 2004/09/21

More Info

Hematuria, or the presence of blood in urine, can be a concerning symptom for many patients. It can arise from various causes, ranging from benign conditions to more serious underlying issues. Understanding the potential causes, diagnostic processes, and necessary next steps is crucial for patients experiencing this symptom.

Causes of Hematuria
1. Urinary Tract Infections (UTIs): Infections in the bladder or kidneys can lead to inflammation and bleeding.

2. Kidney Stones: Stones can cause irritation and damage to the urinary tract, resulting in bleeding.

3. Benign Prostatic Hyperplasia (BPH): In men, an enlarged prostate can lead to hematuria.

4. Tumors: Both benign and malignant tumors in the kidneys, bladder, or urethra can cause blood in the urine.

5. Trauma: Any injury to the kidneys or urinary tract can result in bleeding.

6. Inherited Conditions: Conditions like Alport syndrome or polycystic kidney disease can also lead to hematuria.

7. Medications: Certain medications, particularly anticoagulants, can increase the risk of bleeding.

Diagnostic Process
In your case, it seems that a thorough diagnostic process has already been initiated. Here are the steps typically involved:
1. Medical History and Physical Examination: A detailed history of symptoms, including any pain, frequency of urination, and associated symptoms, is essential.

2. Urinalysis: This test can confirm the presence of blood and check for signs of infection or other abnormalities.

3. Imaging Studies: Ultrasound and CT scans are commonly used to visualize the kidneys and urinary tract. In your case, a renal ultrasound and intravenous pyelography (IVP) were performed.

4. Cystoscopy: This procedure allows direct visualization of the bladder and urethra, which can help identify tumors or inflammation.

Your Situation
From your description, it appears that you have undergone several diagnostic tests, including renal ultrasound, bladder function tests, and cystoscopy. The findings suggest that while there may have been some previous issues (like kidney stones), the current assessments indicate no active bleeding or significant abnormalities in the bladder or ureters. The presence of "dirty urine" could suggest a mild infection or inflammation, but since you report no discomfort, it may not be a significant concern.

Next Steps
1. Follow-Up: Given that your symptoms have not progressed and no significant issues were found, regular follow-up appointments with your urologist are advisable. This will allow for monitoring any changes in your condition.

2. Hydration: Continue to stay well-hydrated, as this can help dilute the urine and potentially reduce irritation in the urinary tract.

3. Symptom Monitoring: Keep track of any new symptoms, such as pain, changes in urination frequency, or any other unusual signs. If you notice any concerning changes, contact your healthcare provider promptly.

4. Further Testing: If hematuria persists or worsens, additional tests may be warranted, such as a CT scan or repeat cystoscopy, to rule out any underlying issues that may not have been detected previously.

Conclusion
In summary, while hematuria can be alarming, many cases are benign and can be managed with careful monitoring and follow-up. Your proactive approach to health, including regular check-ups and attention to hydration, is commendable. If you have any lingering concerns or if your symptoms change, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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