HEMATURIA

Hematuria is a word used to refer to blood in the urine. "Gross" hematuria refers to blood that can actually be seen in the urine. The urine may appear red in color or have a "rusty" or "tea color" to it. Microscopic hematuria refers to blood which cannot be seen but which is detected on urinalysis either by a chemical dip stick test or by examination of the urine under a microscope. When hematuria is present the urinary tract requires evaluation.

The urinary tract begins with the kidneys. The kidneys, one on each side, sit high in the upper abdomen partially underneath the rib cage. They filter the blood to extract excess waste products and fluid to form the urine. Urine, once formed in the kidneys, travels through a tube on each side, the ureter, down to the bladder. Urine is onstantly being made by Be kidneys and transported through the ureters into the bladder. The bladder stores urine until full and then empties to the outside through the urethra. The urinary system is the same in both men and women from the kidneys to the bladder. In men the urethra is longer and encircled by the prostate which is a gland that is part of the the reproductive sytem.

When blood is present in the urine, it may not be a sign of anything which poses a significant threat to the health. However, the goal of an evaluation for hematuna is to determine if there is some underlying problem in the urinary system which requires further attention. There are multiple different causes for hematuria. Problems in the kidney and ureter can include infection, obstruction, scar-ring, stone or tumor. Similar problems can occur in the bladder and urethra. A common cause of blood in the urine in both men and women is mild inflammation in the lower portion of the bladder. Another common cause of blood in the urine in men is Benign Prostatic Hypertrophy. This term refers to the normal enlargement of the prostate that occurs in all men beginning at the age of 40. Another common cause of hematuria is the loss of a few blood cells into the urine as the kidney filters the blood.

Evaluation for hematuria usually begins with a study of the upper part of the urinary system. Information about the kidneys and the ureters is usually obtained with a sonogram or an Intravenous Pyelogram (IVP). A sonagram, or an ultrasound study, uses sound waves to take a picture of the kidney. An IVP is carried out by injectiong contrast (dye) into one of the veins of the back of the hand or arm. This dye is then filtered through the kidneys and the ureter and causes them to show up on an x ray. Both of these studies provide indirect information about the bladder as well.

The lower part of the urinary tract, the bladder and urethra, is usually studied by cystoscopy. Cystoscopy refers to the visual inspection of the bladder and urethra. This is carried out by inserting a small fiberoptic catheter into the urethra and the bladder which allows direct visualization of these structures. This may be carried out under a local anasthetic in an examination room in the office. Sometimes in men, due to the length of the urethra, it is too uncomfortable to carry out cystoscopy in the office and in this circumstance cystoscopy is done in the hospital with IV sedation.

Other tests may be done as well. A urine culture and sensitivity may be done to check for infection. Urinary cytology may help determine if there are any cancerous or precancerous cells that are being shed in to the urinary system. Cytology is carried out by doing a "pap smear" on the voided urine.

Based on the results of the above studies it is may be necessary to carry out further studies such as a CAT Scan, an MRI study, or a retrograde pyelogram. If the ureters cannot be visualized well, or appear abnormal on the IVP or sonogram, a retrograde pyelogram study is carried out at the time of cystoscopy by inserting a small catheter into the ureter. Dye is injected through this catheter to demonstrate the ureter. This is typically carried out in the out-patient area of the hospital where the xray unit is available to make the necessary pictures.

If an abnormality is discovered on the above studies then appropriate recommendations are made for treatment. In most cases, the findings on the initial sonogram or IVP and cystoscopy are benign and nothing further needs to be done. Again, the main goal of evaluation is to make sure that the blood in the urine is not a sign of something which may pose a threat to the patient's health. In the case where nothing serious is found, syptoms to watch for in the future which may indicate a sign of a problem include a change in the urinary pattern to more frequent urination, blood that can be seen in the urine, painful urination or pain that originates in the kidney. Kidney pain typically originates high in the back under the ribs and radiates down to t he groin area. If these syptoms develop then repeat evaluation may be indicated.

Hematuria is a common problem and with the appropriate workup, the necessary treatment can be carried out.