Cause Of Blood In Urine In Males – “Gross hematuria” occurs when the urine appears red, brown, or tea-colored due to the presence of blood. Hematuria can also be subtle and detectable only with a microscope or a laboratory test.

The blood that mixes and mingles with the urine can come from anywhere in the urinary system, including the kidneys, ureter, urinary bladder, urethra, and in m, the prostate.

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Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral disease, trauma, bladder cancer, and exercise.

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These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney.

Other substances, such as certain medications and foods (for example, blackberries, beets, food dyes) can make the urine appear red.

Training in women can also cause the appearance of hematuria and can result in a positive urine dipstick test for hematuria.

A urine dipstick test can also give an incorrect positive result for hematuria if there are other substances in the urine, such as myoglobin, a protein excreted in the urine during rhabdomyolysis. A positive urine dipstick test must be confirmed with microscopy, where hematuria is defined by three or more red blood cells for a high-power field.

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When hematuria is detected, a thorough history and physical examination with appropriate further evaluation (eg, laboratory tests) can help determine the underlying cause.

Many causes can be as visible hematuria or microscopic hematuria, and thus the differential diagnosis is often organized based on glomerular and non-glomerular causes.

While the urine dipstick test is able to recognize heme in red blood cells, it also identifies free hemoglobin and myoglobin.

Free hemoglobin can be found in the urine resulting from hemolysis, and myoglobin can be found in the urine resulting from rhabdomyolysis.

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Thus, a positive dipstick test does not necessarily indicate hematuria; rather, urine microscopy showing three more red blood cells per high-power field confirms hematuria.

In women, training can cause the appearance of hematuria and can result in a positive urine dipstick test for hematuria.

Menstruation can be excluded as a cause of hematuria by asking about the history of menstruation and ensuring that the urine specimen is collected without menstrual blood.

The assessment of hematuria is dependent on the visibility of blood in the urine (eg, visible/gross versus microscopic hematuria).

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Hematuria alone without accompanying symptoms should be suspected of malignancy of the urinary tract until proven otherwise.

The initial evaluation of patients presenting with signs and symptoms that consist of hematuria includes assessment of hemodynamic status, the underlying cause of the hematuria, and safe urinary drainage. These steps include assessment of the patient’s heart rate, blood pressure, a medical examination by a health care professional, and blood work to ensure that the patient’s hemodynamic status is adequate.

It is important to obtain a detailed history from the patient (ie recreational, occupational and medication exposure) because this information can be useful to suggest a cause of hematuria.

Physical examination can also be helpful in identifying a cause of hematuria as certain signs found on physical examination may suggest specific causes of hematuria.

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In any case, the initial evaluation of the hematuria does not reveal an underlying cause, the evaluation by a doctor who specializes in Urology can proceed. This medical evaluation may consist of, but is not limited to, a history and physical examination taken by health personnel, laboratory studies (i.e. blood work), cystoscopy and specialized imaging procedures (e.g. CT or MRI).

The first step in evaluating red or brown urine is to confirm true hematuria with urinalysis and urine microscopy, where hematuria is defined by three or more red blood cells. for high power field.

In gathering information, it is important to inquire about rectal trauma, urological procedures, MSEs, and culture-documented urinary tract infection.

If any of these are present, it is appropriate to repeat the urine analysis with urine microscopy in 1 to 2 weeks or after the treatment of the infection.

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If the results of the urinalysis and urine microscopy reveal the glomerular origin of the hematuria (indicated by proteinuria or red blood cell casts), the consultation of a nephrologist should be done.

If the results of the urinalysis indicate a non-glomerular origin, a microbiological culture of the urine should be performed, if it has not already been done.

If the culture is positive, the treatment of the infection should follow and the analysis of the urine and the microscopy of the urine should be repeated once complete.

If the culture is negative or if hematuria persists after treatment, CT urogram and cystoscopy should be performed.

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Of note, hemodynamic stability should be monitored and a complete blood count should be ordered to evaluate anemia.

In summary, those with visible hematuria confirmed by urinalysis and urine microscopy and without rectal trauma, urological procedures, MSE, or urinary tract infection should undergo cystoscopy and CT urogram.

This section needs to be updated. Please help update this article to reflect evts rect or new information available. (March 2023)

After detecting and confirming hematuria with urinalysis and urine microscopy, the first step in the evaluation of microhematuria is to rule out major causes.

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Bign causes include urinary tract infection, viral disease, kidney stone, rect intse exercise, mses, rect trauma, or rect urological process.

After the major causes are resolved or treated, a repetition of the urine analysis and urine microscopy is guaranteed for the safe cessation of hematuria.

If the hematuria persists (or if there is a suspected cause), the next step is to stratify the person’s risk for urothelial cancer in low, intermediate or high risk to determine the next steps.

To be in the low risk category, one must satisfy all the following criteria: He has never smoked tobacco or smoked less than 10 pack-years; is a female under 50 or a male under 40; has 3-10 red blood cells per high power field; did not have microscopic hematuria before; and has no other risk factors for urothelial cancer.

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To be in the intermediate risk category, one must satisfy any of the following criteria: Has smoked 10-30 pack-years; is a woman aged 50-59 or a man aged 40-59; has 11-25 red blood cells per high power field; or was previously a low-risk patient with persistent microscopic hematuria and has 3-25 red blood cells per high-power field.

To be in the high risk category, one must satisfy any of the following criteria: Has smoked more than 30 pack-years; is older than 60 years; or has more than 25 red blood cells per high power field in any urinalysis.

For the low risk category, the next step is to repeat a urine analysis with urine microscopy in 6 months or do a cystoscopy and ral ultrasound.

However, if no underlying cause is discovered, hematuria should be reevaluated with urinalysis and urine microscopy within 12 months.

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In addition, for all risk categories, if a nephrological origin is suspected, the consultation of a nephrologist should be done.

The pathophysiology of hematuria can often be explained by damage to the structures of the urinary system, including the kidney, ureter, urinary bladder and urethra, and in m, the prostate.

Common mechanisms include structural disruption of the glomerular basement membrane and mechanical or chemical erosion of the mucosal surface of the urinary tract.

If this does not control bleeding, management should be escalated to continuous bladder irrigation (CBI) via a three-port urethral catheter.

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If a large urethral Foley catheter and CBI fail, an urgent cystoscopy in the operating room will be necessary.

Urosepsis is defined as sepsis caused by a urinary tract infection and comprises approximately 25% of all sepsis cases.

Urosepsis is the result of a systemic inflammatory response to infection and can be identified by numerous signs and symptoms (for example, fever, hypothermia, tachycardia and leukocytosis).

Signs and symptoms that indicate a urinary tract infection is the source of sepsis may include, but are not limited to, flank pain, costovertebral angle tightness, pain with urination, urinary retention and scrotal pain.

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In terms of visibility, hematuria can be visible to the naked eye (called “gross hematuria”) and can be red or brown (sometimes called tea-colored), or it can be microscopic (ie not visible to the eye but detected urosepsis.

In addition to imaging tests, patients may be treated with antibiotics to relieve infection and intravenous fluids to maintain cardiovascular and ral perfusion.

Acute management of the hemodynamic state, in which intravous fluids are not successful, may include the use of vasopressor medications and the placement of a ctral vous line.

Higher rates exist in individuals older than 60 years and those with a prior history of smoking.

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When asymptomatic populations are screed with dipstick and / or microscopy medical testing about 2% to 3% of those with hematuria have a urological malignancy.

These risk factors include age (>35 years), male age, previous or currt smoking, chemical exposure (eg, bzes or aromatic amines), and previous pelvic radiation therapy.

About 5% of people with microscopic hematuria receive a cancer diagnosis. 40% of individuals with gross hematuria (readily visible blood in the urine) receive a cancer diagnosis. Hematuria is the medical term used to describe the occurrence of red blood cells in the urine. These red blood cells can come from the kidneys (which make urine) or from anywhere in the urinary tract.

Seeing blood in the urine can be scary,

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