If you see blood in your urine, with or without symptoms of cystitis, you should contact your GP immediately for further advice
Your GP will normally investigate blood in the urine as a matter of urgency. Most GPs will perform some simple, baseline tests. You may be commenced on antibiotics to treat a presumed infection. However, if the urine test result comes back showing no evidence of infection, you will normally be referred to your local urology department for more detailed investigations using the “2-week wait” (fast-track) system.
Your GP should work through a recommended scheme of assessment for patients with blood in the urine. This will normally include some or all of the following:
Your GP will ask you questions about any recent symptoms, any associated matters (including any drugs you are taking) and will enquire about smoking habits. Exposure to industrial chemicals or to substances that may be related to bladder cancer development are also important. You should inform your GP if you are taking blood-thinning drugs (warfarin, dicoumarin) or if you take anti-platelet treatment (aspirin, dipyridamole, clopidogrel). If the bleeding is painless and associated with clots of blood in the urine, it is likely that he/she will arrange urgent referral to a urologist.
Rectal examinationA general physical examination will be performed, together with a rectal or vaginal examination. Your blood pressure may be measured as part of this examination.
The usual tests performed are:
The actual tests performed will be left to your GP’s discretion. It is common to measure kidney function, clotting factors, prostate-specific antigen (PSA) and to check the blood cells for anaemia or other problems.
A urine test will normally be sent for infection. Your GP may commence you on antibiotics whilst awaiting the result of this test. Fresh urine may also be sent to the laboratory for microscopic examination and to look for cancerous cells. Your GP may arrange a 24-hour urine collection to measure your urine protein levels.
Your GP may arrange an ultrasound scan of your kidneys and bladder, pictured right (or a CT scan of your abdomen) although this is usually performed in the urology department.
50% (half) of patients with visible blood in the urine will have an underlying cause identified but, with non-visible blood in the urine, only 10% will have a cause identified
Although there are many potential causes for blood in the urine, those most often identified are:
Assessment of the cause of blood in the urine at hospital (usually in a so-called Haematuria Clinic) may not identify a definite cause but it will, normally, rule out significant causes which require further urological treatment
Your GP may decide that you do not require any further tests at this stage. In this case, you should have regular monitoring to assess the following, which may be signs that re-investigation is needed:
Your GP will arrange urgent referral to the Haematuria Clinic of your local urology unit:
This will involve a prolonged outpatient appointment when some or all of the following assessments will be performed:
This may involve one or more of the following:
This may involve one or more of the following:
IVU and CT scanning involve an iodine-based injection. You must inform the staff if you have a history of allergy to iodine or to previous X-ray injections.
A flexible cystoscopy
It is performed under antibiotic cover & local anaesthetic using a small, flexible telescope which allows the clinic doctor to see inside your bladder (pictured). If you have concerns about this or have experienced problems with local anaesthetic in the past, you should ask about having your examination under a brief general anaesthetic (i.e. whilst you are asleep). When your tests have been completed, the medical staff will advise you on what to do next:
If an abnormality requiring further treatment is detected, the medical staff will advise you on what treatment is necessary and what this would involve (e.g. admission for telescopic removal of a bladder tumour).
Telescopic removal of a bladder tumour(video courtesy of Dr Manoj Talwar)
If no specific abnormality is found, you should keep a careful eye on your symptoms and report any further bleeding to your GP who will be informed of the result of your assessment.