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6055 harbour park drive midlothian, va. 23112 chesterfield urology web: e-mail: phone: 804.639.7777 fax: 804.739.1021 www.chesterfieldurology.com [email protected] Hematuria – Blood in the Urine Blood is not normally seen in the urine either with the naked eye (gross hematuria) or with a microscope (microscopic hematuria). Causes may include: Infection Stones Prostate Problems Bladder Cancer Kidney Cancer Cancer of the Ureter Physical Activity/Trauma Abnormal Blood Vessels Determining the source of the blood and developing a treatment strategy is generally the same for both gross (visible) and microscopic hematuria. Trying to define the source of bleeding requires evaluating the entire urinary tract and checking for infection and/or malignant cells in the urine. For this reason, several tests may be required: Urine Culture – A sample of urine is sent to the laboratory and any bacteria are grown and identified. This also includes a testing of antibiotics to determine which medications will best treat the infection. Patients who are treated with antibiotics may be changed to a different antibiotic if this testing shows another medication would be more effective. Urine Cytology – A sample of urine is sent to the laboratory and cells that have fallen off of the bladder lining are evaluated under a microscope. If the cells appear cancerous, further evaluation will be required. This generally would mean a biopsy. X-ray Evaluation of Kidneys and Ureters – Generally one of two tests: o CT scan – gives a detailed image of the kidneys and ureters but is costly and involves x-ray exposure o Ultrasound – less expensive and avoids x-ray exposure, but does not provide as good of an image of the kidneys and generally doesn’t show the ureters. Cystoscopy – looking in the bladder with a scope. A procedure done in the office and generally well tolerated. Please see “Cystoscopy”. Outcomes: Many times these studies will not show any obvious reason for the bleeding. However, when problems are found they are generally found early and are able to be treated easily. Diagnosis and treatment options will be discussed with you by your urologist. If the problem is very small, it is possible the initial studies may miss it – further evaluation may be needed if the bleeding persists or returns.