blood in urine

[John]

I am a 32 y/o w/m.  Had blood in my urine for about 3 days. I went to the Doctor, and recieved antibiotics and felt my testicals and didnt feel anything abnormal, so I am assuming.  The urine became normal after a couple days of taking the antibiotics.  I had a culture taken and was told it was negative.  What does a negative culture mean?  I have had blood in my urine 2 or 3 times in past 15 years, and ususally went away with antibiotics, and was determined to be an infection.  I am un-circumsized and am unable to find  out family medical history.  I am beginning to think I feel a discomfort, not really a pain, every now and then in left testical.. I don't know if it is Pscycological or actual something there.

[HFHS M.D.-BE]

Dear John,
The presence of blood in urine (hematuria) in a young man, especially if it has occurred more than once, deserves to be investigated.  
A full work -up consists of a history and physical exam to direct the studies such as  IVP ( an X-ray study to look at the kidneys an ureters), a cystoscopy (looking in the bladder with a lighted telescope)which is done by a urologist, and a cytology looking for abnormal/cancerous cells in the urine.
There are different causes for hematuria. One possible cause is a urinary (kidney or bladder)stone.
Another cause could be due to infection of the bladder or the kidneys, which could be found on the urine analysis(UA) and urine culture.  A urine sample should be refrigerated and cultured within 24 hrs. of collection, since otherwise it may not grow to give a proper answer.  Sometimes a negative urine culture may suggest the presence of tuberculosis in the urinary tract.
A third possible diagnosis would be bladder cancer.  Some times bladder cancer presents with blood in the urine and irritative symptoms ( such as urinary urgency and frequency). This is why we perform cystoscopy, to rule out any suspicious lesions/tumors 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.
Other causes would include kidney tumors, abnormal blood vessels, tuberculosis, trauma, inflammation,  idiopathic (simply meaning, we don't know the cause), and individuals with bleeding disorders.  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 rule out any other possible causes that may need to be treated.  
As far as being uncircumcised, it is unlikely to be the source of the problem, especially at your age.
According to your history you may only be suffering from an infection,  but you have to find out why, since this an unusual condition in an otherwise healthy, young man. I would suggest that you see a urologist for 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. B.E.
*keyword: Hematuria

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