Blood In The Urine

CT urograms provide exquisite detail of the kidneys, ureters, and bladder.

Last year one of my friends called me, expressing concern that her family doctor found blood in her urine during a routine examination. She couldn’t see any blood, and in fact she felt fine. This condition, called hematuria, has many benign causes, but my friend was understandably worried because it could also be a symptom of a more serious condition such as cancer.

Q: What are the types and causes of hematuria?
A: Hematuria (blood in the urine) can be seen in up to 21 percent of the population. In fact, up to 18 percent of normal individuals can have some degree of hematuria. However, it can be a symptom of an important medical condition requiring work-up and treatment. Things that can cause hematuria include kidney stones, infection or injury to the bladder and/or kidneys, overly aggressive exercise, and cancer. In men, prostate enlargement or prostate infection can cause hematuria. There are two types of hematuria. Gross hematuria is visible blood in the urine. Often the urine is red or brown and occasionally contains clots. Microhematuria is indicated by red blood cells in the urine and can only be seen under a microscope. Microhematuria is often an incidental finding discovered on urine tests as part of a routine medical evaluation.

Q: How is hematuria worked up?  
A: Painful hematuria is more likely to have a non-cancerous cause such as the passing of a kidney stone or a urinary tract infection. Painless hematuria may also have a benign cause; however, cancer is also a possibility that should be considered. A detailed analysis of the urine should be performed to look for signs of kidney disease and to detect cancer cells. Often a urologist will have to perform a cystoscopy. This is a procedure that uses a tiny camera to look inside the bladder to provide a more detailed view. 

Q: What is a CT urogram? 
A: The diseases that cause hematuria can occur can anywhere from the kidneys (which makes urine) to the bladder (which stores the urine) to the ureters (the tubes that carry urine from the kidneys to the bladder). One of the most effective diagnostic tools for this condition is the CT urogram. During this process, a CT (CAT) scan uses an x-ray beam that rotates around a patient’s body to be absorbed by detectors. A computer processes the informa-tion to create images. Intravenous contrast is injected into the patient so it can be taken up by the kidneys, ureters and bladder. Using the most sophisticated computer software, the radiologist can recreate and analyze the kidneys, ureters, and bladder in exquisite detail. This examination can accurately look for kidney stones as well as kidney infections. The real advantage of this test is the ability to detect very small cancers in these organs.  

Q: What if a patient cannot have a CT urogram? 
A: The CT urogram requires injecting a small amount x-ray dye into the veins. If a patient has a dye allergy or has poor kidney function that prevents the safe administration of the x-ray dye, a CT scan without a contrast injection can be performed instead. In addition, MRI and ultrasound of the kidneys and bladder can be performed to examine these organs. The good news for my friend is that her CT urogram was negative and her hematuria was cleared up without treatment. Much to her relief, her hematuria was due to aggressive exercise (she was training for a marathon around that time). But only by taking pro-active steps to obtain an accurate diagnosis was she able to obtain this peace of mind. 

As always if you have any question, please do not hesitate to contact our staff, 732-244-0777.