What should you do when you see blood in the urine?
The presence of blood in the urine, at any age is the most important symptom in urology. It should never be passed off and must always be dealt with by a urology consultation. This symptom is called “Haematuria”.
Blood in the urine can be microscopic: Blood cells in the urine in excess but not sufficient to be visible to the naked eye is called “ Microscopic Hematuria”. Here Red blood cells (RBC’s) are seen in the urine. Normally the kidney does not filter RBC’s like the size of the filtration unit (glomerulus) does not permit it. So when RBC’s are seen in the urine it raises a red flag. A single test report showing less than 10 RBC’s can be ignored but if repeat examinations of urine show > 10 RBC for every high power field or numerous RBC’s are seen in the urine we call it significant microscopic hematuria.
“Gross Haematuria” is visible to the naked eye. The urine appears pink or red in colour
The source of blood in the urine can be the kidney, ureter, bladder, prostate, urethra or even from diseases of nearby organs like female genital organs and the intestine. Infections, stones, tumors, birth defects, tuberculosis, schistosomiasis, bleeding disorders and trauma of any of these organs can present as hematuria.
Painful versus painless:
Abdominal pain which may be severe can be due to stones, infections of the kidney or blockage of the kidney or even tumors. Pain during urination can be due to infections or stones or bladder tumors and prostate diseases.
When hematuria is painless especially in smokers and associated with clots it is more serious and can be due to tumors of the bladder of kidneys.
Sometimes the shape of the clot can give us a diagnosis. Long worm like clots can be due to bleeding from the kidney and large shapeless clots can be due to bladder tumors. The presence of blood clots in the urine is indicative of a large amount of bleeding and some underlying serious condition. A history of injury or bleeding disorders is important as when there is underlying disease minor issues can lead to bleeding and should be investigated.
What to do next?
Whatever be the situation is there is blood in the urine on microscopy or visible to the naked eye a detailed urological consultation is needed.
1: A detailed physical examination: The urologist has to physically e for general condition, abdominal condition and the condition of the genital organs and prostate. This may involve digital rectal examination (DRE).
2: Laboratory tests such as routine blood tests, creatinine, urine examination, urine culture. Sometimes tests for blood clotting may be needed especially for patients taking anticoagulants. Urine cytology where cancer cells that are shed in the urine can be detected.
3: Ultrasound examination: This is a noninvasive test done by expert radiologists and most of the internal organs including the urinary tract can be seen from outside
This Ultrasound examination of the kidney shows “hydronephrosis: or enlargement of the kidney due to accumulation of urine within it due to blockage of the urinary passages either from birth or due to stones or other causes
4: CT Scan: This is a computer-generated image that is highly accurate by which the entire urinary tract and other abdominal organs can be defined with a high degree of accuracy.
Large right kidney stone
Large right kidney tumour
5: Cystoscopy/ ureteroscopy: It may be necessary to examine the interior of the bladder, ureters and kidneys in rare situations where all the tests remain inconclusive.
Whenever there is blood in the urine it needs detailed urological evaluation.