What is Hematuria?
Hematuria is the presence of blood in the urinary tract and is a fairly common entitiy. Blood can be either gross bleeding (gross hematuria) which is visualized with the naked eye and easily detected by the patient or microscopic hematuria that is only detected with the use of a microscope.
Some of the more common risk factors for the development of hematuria include cigarette smoking, chemical exposure or radiation exposure to the urinary tract.
Blood can be arising from any portion of the urinary tract. The urinary tract consists of the kidney, (the organ that filters the blood and forms the urine), the ureter (the tube that transmits the urine from the kidney), the urinary bladder (the organ that stores the urine), or the urethra (the tube that brings the urine from the bladder to the outside world). In the male, the prostate is another source of potential bleeding.
Bleeding can be identified in the initial portion of the urinary tract which usually is associated with a source of bleeding that is located closer to the urethra, throughout the urinary stream (total hematuria) or terminally, which is associated with the end of the urinary stream and more likely from the bladder or higher up.
Hematuria may be painful or painless. Some of the more common causes of painful hematuria include kidney stones, urinary tract infections or other obstructions of the urinary tract. Painless bleeding may be associated with malignancy of the urinary tract.
Some causes of red urine that is not blood may be due to foods that contain a red pigment and may include beets or foods with artificial coloring. Certain medications may also be associated with red discoloration and a common example of this is the drug rifampin (a drug used to treat TB).
Urologists tend to deal with bleeding that is extraglomerular in nature, or blood that is not associated with the parenchyma (outer portion or filtration system) of the kidney, the exception being renal tumors that arise in the renal parenchyma. A typical evaluation for hematuria will involve a urine test known as a cytology which will look for cellular abnormalities that may be associated with cancer, an imaging study of the urinary tract (sonography or CT scan), and often a cystoscopic evaluation which is an evaluation of the lining of the bladder that is performed with a fiberoptic instrument.
Early detection of the cause of the hematuria is often times very important as it may be associated with a serious underlying problem. If you experience bleeding, seek help from a Urologist and do not put off the necessary evaluation.
Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.