Question Title: Microscopic hematuria since 1996 - History of bladder cancer in the family

Dear Doctors,
I am a 29 year old woman, nonsmoker, who has had moderate microscopic hematuria
positive for red blood cells,and leukosyte esterases show up in UA's since Jan 1996. I had a MRI of abdomen and pelvis and a cystoscopy done in april 1999 which came back negative. The urologist said everything looked "clear". Continued urinalysis' still show the blood with no evidence of urinary infection.

My Urologist also ordered a Nuclear Matrix Protein 22 test witch indicates:
"In range 4.7" and a urinalisis wich indicates :"within range"

I have been told that this symptom is "a normal variant". Since my father has bladder cancer "transitional carcinoma stage II", (detected in March 1999) I was wondering if I may too have a lesion in the urinary tract that will eventually triger some form of cancer development if left untreated.

What are some other tests my doctor could order in order to find out where the bleeding is comming from?.

Thank you,
Cora

Dear Cora,
Hematuria is the medical term for your condition. It is important to have a microscopic cell count done to determine if this amount of hematuria needs to have a full work-up. Above 3 RBC/HPF is suggestive of significant hematuria that needs work-up.
A full work -up consists of a history and physical to direct the studies ,an IVP, a cystoscopy which has been done, and a cytology looking for cancerous cells in the urine. About 30% of patients at our institution have some pathology causing there hematuria.
Considering the symptoms that you have, a urinary stone could be a possibility, however, with a negative IVP this would be less likely. Some stone are made of Uric acid and are not seen on IVP.
You could also have an infection. If you have been febrile or have had flank pain, you should be evaluated for a possible kidney infection. Also, blood in the urine could be caused by a simple infection of the bladder, which could be found on the Urine analysis(UA). If you have a bladder infection, you may be treated and just wait until the hematuria it clears.
A third possible diagnosis would be bladder cancer. Some times bladder cancer presents with blood in the urine and irritative symptoms. This is why we perform cystoscopy, to rule out any suspicious lesions in the bladder. The cystoscopy also allows the urologist to examine the anatomy of the bladder and position of the ureteral openings in the bladder.
Our last diagnosis would be idiopathic, simply meaning, we don’t know. Patients that exercise or have bleeding disorders can often have blood in their urine without a good explanation. These patients get the same work-up listed above to ensure they don’t have a treatable condition.
I would suggest you have a repeat UA and if the microscopic analysis is high, RBC>3/HPF you may want to have an IVP. To answer your question directly, there is no lesion in the bladder that will cause bladder cancer. Since you have a family history and you are concerned about your microscopic hematuria I think periodic urine analysis would be safe. Ask your urologist what his recommendations are and follow their plan.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Hematuria

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