A 56-year-old man who has been smoking a pack of cigarettes a day since age 18 noticed some blood in his urine on two occasions. It was painless but he was concerned and paid me a visit. He also has noted difficulty urinating, and a slow urinary stream. He wanted me to reassure him that the blood in the urine was trivial.
The urological term for blood in the urine is haematuria. Blood in the urine is NEVER normal and must ALWAYS be evaluated. Blood in the urine may be microscopic and noted only on a urine test in the doctor's office or analysis from the lab. Blood in the urine may also be gross, that is, seen with the naked eye.
What could possibly cause blood in the urine in a man?
There are many causes of blood in the urine. They may range from minor conditions such as a urinary tract infection to more frequently seen urinary tract stones. Other causes include an enlarged prostate (Benign prostatic hyperplasia - BPH), prostatitis, medication use or bleeding due to sickle cell disease. However, it is always important to exclude cancers such as prostate cancer and bladder cancer. Microscopic blood in the urine is associated with a cancer in 10 per cent of persons. In this particular man, a long history of cigarette smoking will increase his risk of bladder cancer. However, he does admit to difficulty urinating so we must also consider the possibility of BPH.
How common is bladder cancer associated with blood in the urine?
Blood in the urine is the most common sign of bladder cancer. Eighty to 90 per cent of persons with bladder cancer will have painless gross blood in the urine.
What tests are needed if there is blood in the urine?
There are several tests required in anyone who has blood in the urine. These include urine analyses to determine the quantity of blood, the presence of proteins and other substances which may indicate kidney disease and also a "culture" to exclude bacteria that may be causing an infection. A urine cytology is a test that examines the cells shed from the bladder and determines if they are cancerous.
Commonly performed blood tests in this situation include a check of the man's blood count (haemoglobin), a sickle cell test, kidney function tests, and prostate specific antigen (PSA) -- to screen for prostate cancer and bleeding tests.
All men with blood in the urine must have at least an ultrasound of the urinary tract and have a test done called a flexible cystoscopy. This involves inserting a small scope into the bladder under anesthesia to examine the bladder wall and urinary passage to determine the source of the bleeding.
How is blood in the urine treated?
Blood in the urine is treated based on the underlying cause. Simple measures such as drinking lots of fluids may help to reduce bleeding if it's visible.
There are many causes of blood in the urine. These may be life-threatening and therefore symptoms should be evaluated and treatment sought.
Dr Belinda F Morrison is a urologist and lecturer at the University of the West Indies. Contact her at Belinda.firstname.lastname@example.org.