Blood in Urine is Cancer until Proven Otherwise

  • The major difference between microscopic and gross hematuria is the incidence of significant pathology.
  • Dipstick test needs to be confirmed with microscopic urinalysis
  • Microscopic Hematuria

    1-2% risk of malignancy; up to 5% with multiple risk factors


    Gross Hematuria

    18% risk of malignancy; up to 30% with multiple risk factors

  • Risk Factors


    • Age >40
    • History of Smoking
    • Prior Pelvic Radiation
      (Colon, Prostate, Uterine)
    • >25 RBCs/HPF
    • 3 times
    • 4 times
    • 2 times
    • 12 times

    Population-based standardized incidence ratios of bladder cancer.

  • Blood in Urine is Cancer until Proven Otherwise

    • Bladder cancer is the most common diagnosis in patients with hematuria after kidney stones and BPH in men.
    • The symptoms of benign diseases are often indistinguishable from malignant or life-threatening causes.
    • Bladder cancer can present with symptoms similar to UTI: frequency, urgency, nocturia.
    • Natural history of gross hematuria is that it may often resolve spontaneously only to recur. Empiric treatment with antibiotics may give an impression that antibiotics are effective.
  • 2.4 % of men and women will be diagnosed with bladder cancer

    • Patients on blood thinners have similar rates of malignancy after evaluation for hematuria as those not on anticoagulant medications.
    • The risks are increased in current smokers; risk persists as long as 20 years after cessation of smoking
    • Bladder cancer is the most common secondary cancer after radiation to the prostate.
  • Fewer than 15% of patients with hematuria receive the recommended evaluation within 1 year of initial diagnosis

    • “incidence and mortality rates have changed very little over the past 20 years” according to the (NCI).
    • Early detection is the key to improved survival. Delay in bladder cancer treatment by 90 days is associated with higher mortality rates.

  • If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call  1 (646) 663-5515