Question Title: Hematuria

My father is 67 years old, and has gout that occasionally cause painful ankle
conditions. Few days ago, he noticed blood in his urine, 8 PM and 10 PM in the
same day. He said it was bright red, string like blood seen close to the last
section of the urine (but the very last section was clear). He did not feel any discomfort. It never happened before or after that.

We went to see an Internal Medicine doctor, 3 days after the incident, who found my dad's prostate a little enlarged but considered that normal for his age. Urine exam returned all normal, no blood or protein present. My dad has heavy
calcification of his kidney tissue for a couple of decades now. A couple of years ago, ultrasound suggested he had kidney stones but no treatment was
effective so the doctors think it was not stones but calcification of kidney
tissue itself. My dad never smoked, and hasn't drunk alcoholic beverage for a couple of years.

So, this doctor we saw thinks it is something wrong in the bladder, but did not
tell us what kind of bladder condition can cause such hematuria. My parents are
just visiting me from China, so they don't have health insurance. We made an
appointment to see an urologist, who is on vacation and won't be back for another couple of weeks. I am anxious to know the possibility of bladder cancer,
and we are wondering if they have to cut the visit short and return home for
more exam and/or treatment. I am also interested to learn any low cost health
facility in the Bay Area for such conditions.

Thank you very much for your information in advance.

Li

Dear Chris,
Hematuria is the medical term for your father’s 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. With the history of gross hematuria I think a work-up should be done regardless, but this decision will be left up to your urologist.
A full work -up consists of a history and physical to direct the studies ,an IVP, a cystoscopy which should be done by a urologist, and a cytology looking for cancerous cells in the urine. About 30% of patients at our institution have some pathology causing there hematuria so 66% of the time there is nothing found..
He could also have had an infection. If he was febrile or had burning when he urinated blood in the urine could have be caused by a simple infection. This could be found on the Urine analysis(UA). If he has a bladder infection, he may just wait until it clears. If the UA is negative, the cystoscopy may not be necessary.
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 or strain to urinate with large prostates, 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 your father have a repeat UA and if the microscopic analysis is high, RBC>3/HPF, go and see a urologist a full evaluation.
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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