Haematuria (or red discoloration of the urine) is almost always due to blood in the urine.
This may be:
– macroscopic (or visible red discoloration) or
– microscopic (where the urine looks normal and the blood is found on testing the urine with a dipstick test or in a laboratory (an MSU or mid-stream urine test).
Blood in the urine may be due to a number of causes, such as kidney inflammation (glomerulonephritis), urinary tract infections, kidney stones, prostate disease or kidney or bladder cancer.
If you see blood in your urine you need to see your GP urgently. They will do tests which may include:
- A mid-stream urine test (MSU for M,C+S) – this confirms bleeding and can diagnose urinary infection
- Blood tests, including kidney function, FBE and PSA
- Urine cytology – to see if there are any abnormal or cancer cells in the urine under the microscope
- Ultrasound of the urinary tract or CT/IVP
If there is bleeding without infection, you will probably need referral to a Urologist or Renal Physician.
What does a Urologist do?
- Initial consultation – medical history, physical examination and a review of all Pathology and Radiology results
- Diagnostic Flexible Cystoscopy
What is a Flexible Cystoscopy?
A Flexible Cystoscopy is a procedure where a small flexible fibreoptic telescope is passed up through the urethra and into the bladder to try to find the cause of the bleeding. It can also be done to investigate the cause of urinary infections or lower urinary tract symptoms.
The procedure is done using local anaesthetic gel (there are no needles!) There may be some discomfort, but it is not usually painful. Fluid is flushed in to fill your bladder. The images from the telescope are shown on a television screen, and you can watch (if you want to!).
The procedure only takes a few minutes, and is done as a walk-in, walk-out procedure in the Bendigo consulting rooms or in a hospital Day Surgery Unit.
What is Urothelial cancer of the Bladder?
Urothelial tumours (which are usually cancer) grow from the cells lining the urinary tract (in the calyces in the kidney, renal pelvis, ureter, bladder and urethra). These are usually slow growing superficial cancers, but some are more aggressive and can invade into the wall of the bladder.
The first sign of bladder cancer is usually blood in the urine. Most bladder cancers are detected using a combination of ultrasound, CT scan and/or diagnostic flexible cystoscopy.
Urothelial Cancer of the Bladder – Treatment
Urothelial cancer of the bladder is treated by Trans-urethral resection of the Bladder Tumour (or TURBT).
A Trans-Urethral Resection of Bladder Tumour is a procedure performed under an anaesthetic (general or spinal) in hospital. A telescope (called a resectoscope) is passed up through the urethra into the bladder. The resectoscope can remove (or resect) a bladder tumour or any other suspicious areas which are then sent to pathology. There may be some bleeding for the first few weeks until the lining of the bladder heals.