Treatment of Blood in Urine in NYC in Men and Women
What is Hematuria?
Hematuria is a medical term for ‘blood in urine”.
How is Hematuria Diagnosed?
In a Physician’s office, hematuria can be identified by
- Patient’s medical history. If a patient noticed bloody or brown urine, further evaluation is necessary. The diagnosis is made by history. Evaluation is necessary even if blood in urine has disappeared.
- The patient is assessed for factors placing them at a higher risk of significant urological disease. These include age (>40 years), past or current analgesic abuse, smoking or exposure to chemicals or dyes; history of pelvic irradiation, gross hematuria, irritative voiding symptoms, urinary tract infections (UTI), current medications, prior UTI interventions, presence of blood clots in urine, recent strenuous exercise, and a family history of renal disease.
- Physical examination is directed to detect signs of acute glomerulonephritis such as hypertension and volume overload. The abdomen, pelvis, and prostate are examined for masses or tenderness, and the urethral orifice is visualized.
- The laboratory evaluation of hematuria is directed toward identifying potentially serious or reversible causes. The initial laboratory evaluation of hematuria is limited to a urine culture (to rule out bacterial infections), blood urea nitrogen, serum creatinine levels, and a microscopic urinalysis to indicate the patient’s overall renal function.
Urinalysis comprises of the dipstick test and microscopic examination of urine. A urine protein reaction of greater than 1+ (hemoglobin 0.06 mg/dL)) on the dipstick in a patient with hematuria may point to a glomerular lesion.
Microscopic evaluation which demonstrates red blood cell casts is highly suggestive of glomerulonephritis, and their presence can direct further evaluation.
If no erythrocytes (red blood cells) are seen, pigmenturia, such as hemoglobinuria or myoglobinuria, may be present and a 24-hour urine collection is done to quantify the urinary protein.
Cystoscopy is performed to evaluate the bladder and urethra.
Imaging studies such as ultrasound scan, Computed Tomography Urography, and Magnetic Resonance Urography are suggested which are rapid diagnostic imaging tests and have the highest degree of sensitivity and specificity.
There has been some debate about the recommended follow-up for patients with microscopic hematuria. New York Urology Specialists practice evidence-based medicine and the exact approach is refined continually based on the latest scientific findings. Close follow is especially important for persons older than 40 years and younger persons who have risk factors such as smoking and history of pelvic radiation or prior malignancy.
Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating some of the most complex urology problems in men. He has treated hundreds of men and women with blood in urine, kidney stones, bladder stones, enlarged prostate, bladder cancer, UTI, prostate, and kidney cancer.