Types of hematuria
- Gross hematuria - blood visible to the naked eye: urine pink, red or the color of meat slop
- Microhematuria - red blood cells are detected only when examining urine under a microscope; there are usually no complaints
- Initial - blood at the beginning of urination, most often indicates damage to the urethra
- Terminal - blood at the end of urination, characteristic of the bladder neck and prostate
- Total - urine is uniformly colored in all portions, the source is located in the kidney, ureter or bladder
- Painless - not accompanied by any other symptoms; most suspicious for a tumor
What can color urine other than blood?
- Beets, blackberries, rhubarb and foods with dyes
- Some medications
- Increased urate content
- Muscle breakdown after extreme physical activity - myoglobinuria
- Blood from the genital tract in women during menstruation
It is simple to distinguish these conditions from true hematuria: it is enough to take a general urine test, where red blood cells will either be detected or not.
Causes of blood in urine
- Tumors of the bladder, kidney, pelvis and ureter are the main cause that must be excluded first
- Urolithiasis and ureteral stones
- Infections: cystitis, pyelonephritis, urethritis
- Prostate adenoma - due to dilated veins of the bladder neck
- Prostate cancer
- Kidney diseases: glomerulonephritis, IgA nephropathy
- Injuries to the kidneys, bladder, urethra
- Taking anticoagulants and clotting disorders
- After endoscopic interventions and catheterization
- Intense physical activity - so-called marching hematuria
- Renal cysts, vascular abnormalities, renal infarction
Mandatory examination
The examination program for hematuria is standardized and aimed at not missing a tumor. You cannot limit yourself to one ultrasound.
- Urinalysis with sediment microscopy - confirmation of red blood cells and assessment of their shape
- Urine culture to rule out infection
- Ultrasound of the kidneys, ureters and bladder
- CT urography with contrast - evaluation of the kidneys and upper urinary tract
- Cystoscopy is a mandatory method: only it allows you to see the bladder mucosa directly
- Cytological examination of urine for atypical cells
- Creatinine, complete blood count, coagulogram
- PSA in men
- Consultation with a nephrologist for abnormal red blood cells, protein in the urine and increased creatinine
When you need emergency help
- Urine contains clots and urination becomes impossible - bladder tamponade
- Heavy bleeding with pallor, weakness, dizziness
- Hematuria after injury
- Blood in urine with high fever and lower back pain
- Hematuria while taking anticoagulants
In case of tamponade, cystoscopy is performed to wash out the clots, and, if necessary, coagulation of the bleeding vessels of the bladder.
Treatment
Treatment is aimed at the cause - there are no universal “hemostatic” solutions for hematuria.
- For a bladder tumor - TUR of the tumor with histological examination
- For kidney tumors - partial nephrectomy or nephrectomy
- For stones - crushing or removing the stone
- For infection - antibacterial therapy by culture
- For prostate adenoma - drug or surgical treatment
- For kidney diseases - treatment by a nephrologist
- In case of bleeding - endoscopic coagulation and washing of clots
- Correction of anticoagulant therapy together with a cardiologist or therapist
Common patient mistakes
- Ждать повторения эпизода: гематурия при опухоли часто однократная, и повтор может произойти через месяцы, когда стадия уже другая
- Списывать кровь на «застудил почки» и лечиться прогреванием
- Принимать кровоостанавливающие препараты без выяснения причины
- Ограничиваться одним УЗИ и отказываться от цистоскопии
- Не сообщать врачу о приёме антикоагулянтов — на их фоне гематурия часто отражает скрытую урологическую патологию, а не просто побочный эффект
Where to get examined for blood in urine in Tashkent
A full examination requires a laboratory, ultrasound, access to CT and, most importantly, the ability to perform cystoscopy with biopsy.
In Tashkent, examination for hematuria is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic; here, once the cause is identified, endoscopic treatment is possible.
If there was blood in the urine only once and did not happen again, this is not a reason to postpone the visit, but a reason to make an appointment in the coming days. Clinic contacts are below on the page.
