Dear Doctors,
I am a 40 year old woman who has had hematuria (trace to moderate)
show up in UA's since Feb. of 1998. I had a cystoscope and IVP done in
May which came back negative. The urologist said everything looked
"clear". Continued urinalysis' still show the blood. And it has increased
from trace to now, moderate levels with no evidence of urinary infection. Now, I have been told that this symptom is "not normal" yet no reason
has been found. I must mention that I lost my beloved Mother to bladder
cancer at the age of 63 this past July. Her Mother (my Grandma) died
the previous year of urinary cancer. And now, my Mothers only sibling, a sister,
has been diagnosed with bladder cancer. I am not normally a worrier, but with this strong family history I am
naturally concerned. Additionally, I have also been experiencing a tremendous
fatigue and occasionally have drenching sweats at night that wake me
up from sleep. Please will you advise: Could this symptom be an early, yet undetectable sign
of cancer? What are the reasons for persistent hematuria? Though my Doctors
continue to keep an eye out, and they all say blood in the urine is NOT
normal, they have not explained what could be the cause. Thank you in advance for your kind and thorough reply! I am very grateful
for this forum! Sincerely,
CT
Dear CTAlthough most causes of hematuria are benign, urinary tract bleeding may
signal the existence of a life-threatening disease. Gross and microscopic
hematuria shares a common differential diagnosis, including urinary tract
infection, urolithiasis and various cancers. Clinical evaluation may be
guided by the patient's age, sex, medical history and physical examination.
Intravenous pyelography or sonography is usually the first procedure
performed, although cystoscopy is indicated in the face of active bleeding.
Those patients who remain undiagnosed after a complete evaluation should be
followed with routine urinalysis and cytology to allow early detection of
malignancy. Barkin and associates studied 270 consecutive patients who presented with
hematuria over a 12-month period. Using a complete visualization of the
urinary tract by urography and cystoscopy they found a causative lesion in
over 90% (Barkin and associates, Can J Surg 1983 Nov;26(6):501-3). Where a
cause could not be found on the first presentation, the initial evaluation
was repeated within 4 months, revealing the previously missed diagnoses in
four patients. Of patients who bled while receiving anticoagulants, 17%
were found to have an important underlying cause other than anticoagulant
therapy. Despite repeated evaluation, and in many instances more elaborate
investigation with angiography, computerized tomography and
ultrasonography, no reasonable diagnosis could be made in 6% (12% of those
with microscopic hematuria, 4% with gross hematuria). One hundred and
fifty-nine patients with unexplained hematuria, seen between 1975 and 1983,
were studied.
Diagnostic protocols will be partially guided by smoking and family history
of urological cancers. There are few additional tests that can be
performed to further elucidate the cause of hematuria. Even though you
have not mentioned it, you may have already had a urinary cytology performed.
If not, you can request this test. Additionally newer tests are
available which can help in pin pointing the diagnosis. These are as
follows: Urinary Bladder Tumor Antigen (BTA), urinary p53 estimation,
NMP22 and QUANTICYT computer assisted dual parameter image analysis in the
urine sample.
In summary it is difficult to make a diagnosis over the Internet but few
important guidelines are as follows: Untill a definitive diagnosis is made you may benifit from frequent urological consultations including urinary cytology,
BTA test and cystoscopy. Your urologist may consider other imaging tests
in future if he finds any suspicious finding.
This information is provided for general medical information purposes only.
Please consult your physician for diagnostic and treatment options
pertaining to your specific medical condition. The Henry Ford Hospital Department of Urology has experience in the
evaluation and treatment of problems such as you describes. They would be
most interested in helping you. You can reach them through our toll-free
number (1-800-653-6568). We can also arrange local accommodations through
this number if this is your need. Sincerely, HFHS M.D.-A.T. *keyword: Hematuria, cytology, TCC
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