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Your Questions Answered: Blood in Urine

Your Questions Answered

In this month’s Your Questions Answered series we take a look at some of the common urological conditions that people experience.

Mr Leye Ajayi is a Consultant Urological Surgeon at St John and St Elizabeth Hospital, specialising in minimally invasive surgery for urinary tract stone disease, prostate cancer and other conditions of the urinary tract.

Here, he speaks to us about blood in the urine, what it can mean, and what you should do if you are passing blood.

What does blood in the urine mean? 

The medical term for blood in urine is haematuria, and it can occur in two forms. There is non-visible haematuria, when a patient goes to the GP and they dip the urine, and the urine has a trace of blood in it. Then there’s visible haematuria where you can see that you’re passing blood. Visible haematuria is a major concern, and patients need to be urgently investigated because we consider it to be cancer in the urinary tract until proven otherwise.

What does visible blood in the urine look like?

If the blood is visible this can be very alarming for patients; even though 95% of the liquid is urine, it can take on a red or claret colour. In other cases, a patient might notice a drop of blood in their urine which settles with time – and this could be an indicator of bladder cancer.

Can blood in the urine be serious?

The most common cause of blood in your urine, be it visible or non-visible, is a urinary tract infection, and we try to reassure patients of this from the outset. But if a patient has visible haematuria, the first thing we want to do is rule out cancer as the cause.

In this context, cancer refers to the entire urinary tract – including the bladder, the lining of the ureter and the kidney. You can have urothelial cancer within the urinary tract, inside the lining of the kidney, in the ureter which drains the kidneys to the bladder, and also the linings of the bladder. Those are the common kinds of cancer.

The first thing we do is a urine test to make sure the patient doesn’t have an infection. Then we look at risk factors, such as if the patient’s a heavy smoker, in which case their risk of developing bladder cancer rises exponentially. In those sorts of patients, we need to investigate them by looking at the entire urinary tract. The way we do that is to organise cross sectional imaging, in the form of a CT IVU to look at the kidneys, and also to organise endoscopy of the bladder, where we do a cystoscopy to ensure there’s no cancer within the bladder.

We encourage patients who see blood in their urine to present to their doctors as soon as possible, because it’s important to catch bladder cancer early if that’s what’s going on. Often, we find patients have a small bladder tumour, and by removing that we can offer them a cure.

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