Question Title: macrohematuria

dear doctors,
i am also a 5th class medical student and i want to know sth about my father's
disease.my father is 50 years old he smoke for nearly 20 years but gave up smoking for at least 7 years.last year after his miction blood came from his uretra and when he went to hospital his blood controls and urine controls seemed
normal and by ultrasonography they saw stone in the kidney.they also examined my daddy's bladder with sonography too,but found nothing.after 14 months now the bleeding again occured and now the doctors are suspicious from bladdertumor.
the bleeding is after miction and painless.sometimes my dad says that he has a feeling in his uretra like burning or sth like that.what can the problem be please answer me.also he will have IVP and cystoscopy 1 week later.i wanna know if it was cancer or beginning of cancer wouldn't my father's genaral stuation be worse(by this 14 months)he seems so healthy and his weight is ok. and what can be seen by ivp and is there any important risk of cystoscopy.

Dear Mehmet,

Thank you for your inquiry. Hematuria can be classified into two categories microscopic and gross. Microscopic hematuria by definition is red blood cells > 3per high power field viewed under the microsope. Gross is simply red urine. It is impossible to make a diagnoses simply by the type of hematuria, but gross hematuria usually portends a worse prognosis There are numerous causes of both; ranging from benign disease(infection) to cancer. The condition can affect any age group or gender. It needs to be addressed by a physician with a history and physical exam. To help diagnose the etiology of the hematuria in an adult an imaging study of the upper urinary tract( kidneys, ureters) is performed There are more than one imaging modalities available, CT scan, Ultrasound and traditionally IVP. If one of these studies are performed and found to be normal, a cystoscopy is performed to evaluate the lower urinary tract,(bladder, urethra). This allows direct visualization of the uretral and bladder mucosa. Other available test include urinalysis to rule out infection, urine cytology to identify abnomal cell types. The screening tests will usually identify a cause and location of the bleeding. If the bleeding has stopped, the cytology and imaging studies are still effective in making a diagnosis, but it may require further investigation.

Men in this age group are at risk for cancer of the GU tract. The history of smoking also increases the risk of developing cancer in the bladder and kidney. So, it is important to rule these conditions out with the IVP and Cystoscopy. It is difficult to predict the etiology of the hematuria, again it could be from a bladder infection, recurrent kidney stone, enlarged prostate, bladder/kidney tumor. The symptoms of burning usually accompany infection, but cancer must be first ruled out. If the hematuria is from bladder cancer the cancer is most likely superficial, meaning confined to the lining of the bladder, which has a more favorable prognosis than the tumors which invade the muscle wall of the bladder, but this cannot be determined until the time of cystoscopy. Bladder cancer can present in many ways. Hematuria is one of the major signs, the others being irritative voiding with frequency , pain, and unable to hold off urination. As bladder tumors grow and spread thay can cause obstruction of the urinary tract,weight loss, develope pelvic mass, or bone pain.
Cystoscopy has limited risks including infection, hematuria, bladder injury/perforation and stricture, but the benefit outweigh the risks. It is important to make the diagnosis and begin treatment in a timely fashion especially if the diagnosis turns out to be cancer.

This information is provided for general medical education 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 urban campuses by calling 18006536568.

Sincerely,
HFHS-M.D.JS

*keyword:Hematuria

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