As a urologist, I would have thought that after all these years the message would have gotten out – blood in the urine (hematuria) is not normal and must be evaluated 100% of the time. Yet time and time again, I see patients and hear their stories about how they complained to their doctors about seeing blood in their urine. Were they whisked off to a urologist for further studies? Sadly, no. Many of them were told to “come back in several months and we’ll see if the blood is still there” or “we’ll throw antibiotics at you to see if the blood goes away, assuming it’s from an urinary tract infection“, the doctor says, “even though you don’t have any signs or symptoms of infection.”
Many patients do return, but some don’t. Some have persistent blood in the urine and then are sent to the urologist. Others may not have blood at a follow up visit and are then incorrectly reassured that everything is fine. As we in the hematuria business know, blood in the urine just one time is reason enough for evaluation. Bad things can cause blood in the urine off and on, so just because the blood went away does not mean everything is fine. In fact, bad things may be quietly growing, giving out little warnings now and again.
The problem is not blood in the urine itself. Rather blood in the urine is a sign of something. Something that is not right somewhere within the urogenital tract. For men and women. It could be something as simple as a low-grade infection. It might be a bladder or kidney stone, bobbling around causing irritation of the lining and therefore blood. Or it may be an early warning sign of a kidney cancer, ureteral cancer or even a bladder cancer.
Whatever the cause, blood in the urine is not normal at any time and must be evaluated. Sure, if there is an infection, and there’s no more blood after the infection is treated, then no further assessment is necessary. But that is because there was an obvious cause of blood, that when treated, resolved. However if there’s blood in the urine and no evidence of infection, then a trip to the urologist is absolutely necessary. Nonnegotiable.
For some reason, most women have no problem going to see a doctor for evaluation of something that might not be right. Men, on the other hand, are a totally different animal. They will stall, drag their feet, whine, try to come up with far-fetched excuses for the blood, and use their best negotiating skills to weasel out of seeing the urologist. Unfortunately though, this can result in serious problems that can even be life-threatening. If a cancer is present, then oftentimes blood in the urine is usually an early warning sign. A warning sign that should not be ignored. If one were to wait months or years, as urologists see on occasion, then the cancer can go from a small easily treatable spot to become large and even spread to other organs or lymph nodes. Not a good thing.
The workup for hematuria is pretty basic and fairly quick. Not worth all the fuss. The urine is evaluated for signs of infection, and often a sample is sent off for DNA analysis to look for any genetic changes that may suggest cancer (NMP-22 or BTA stat are two examples). An x-ray, usually a CT scan, is performed to look at the kidneys, ureters and the surrounding organs.
Finally, and perhaps this is the reason that most men do their best to avoid going to a urologist, a good physical exam and a flexible cystoscopy are a must. With this, the urologist will pass a tiny, pencil thick, flexible fiber-optic scope up the urethra and into the bladder. The cystoscopy allows for direct vision of the lining of the bladder, prostate and urethra – common places for tumors to hide (and no, they can’t be seen on CT scan). No other test or x-ray provides this information.
The good news is this is done with plenty of lubricating anesthetic jelly, and for the vast majority is only momentarily uncomfortable. It’s not fun but it’s really not that bad. I’ve performed thousands of cystoscopies and I always ask the patients if the procedure was as bad as they feared. Almost without exception I hear, “Actually it wasn’t that bad. Why was I so worried?” I really don’t know. Either way you get good news. Either nothing is found, or something is. Even if a cancer is found, usually they are small and at least you can deal with it and get it taken care of. Then you can move on.
So what if you or a loved one sees blood in the urine? Now you know to demand to see a urologist. Do not settle for anything less. You or your loved one’s life may be at stake.