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The Medical Minute: Blood in the urine often an important warning sign

Blood in the urine can be a scary sight, yet it's a symptom many people ignore until it is bad enough to land them in a hospital emergency department.

Hematuria, as the condition is called, can be caused by a number of things – some of which are more serious than others, but all of which merit a visit to your family doctor. Generally, blood in the urine indicates a condition with the urinary organs including bladder, kidneys or ureters.

Possible causes include kidney stones or, in men, an enlarged prostate. In a smaller percentage of cases, the symptom can be a sign of something more serious such as kidney, ureter, prostate or bladder cancer.

Unfortunately, many people do not seek care for hematuria. In fact, fewer than 50 percent of women who experience the condition ever see a urologist for it.

“Maybe it goes away at some point, and they are reassured not to worry about it. A majority of women attribute it to infection or their menstrual period,” said Dr. Jay Raman, associate professor of surgery and chief of the Division of Urology at Penn State Hershey Medical Center.

Guidelines from the American Urological Association (AUA) recommend seeking a professional opinion the first time it happens. A doctor's expertise and a urine specimen can determine, first of all, whether it is indeed blood. Eating foods such as red beets or rhubarb can discolor the urine, as can dehydration, certain medications and strenuous exercise that causes muscle breakdown.

Microscopic examination of a urine specimen can determine the presence of blood cells, bacteria or crystals that could suggest infections or kidney stones. Specialists recommend imaging of the kidneys and ureters that drain them for a more detailed investigation of underlying causes.

“We can use different protocols on CAT scans to look for potential causes such as tumors, stones or foreign bodies,” Raman said.

Problem is, only a quarter of patients who have blood in their urine ever get imaging to check for such conditions. “Whatever the cause, early detection allows us to find the problem and discuss options for managing it,” Raman said.

In addition to imaging, AUA guidelines recommend a cystoscopy – a procedure that sends a tiny camera up into the bladder to see problems with the bladder or prostate that may not be seen with other scans.

“Most patients are not thrilled about having a procedure like that done – and unfortunately only 10 to 15 percent of patients with hematuria get that,” Raman said. “But we consider it an essential component of evaluation.”

At Penn State Hershey, doctors are studying whether noninvasive tests can accurately predict a patient's risk of bladder or other urinary cancers prior to scheduling a cystoscopy. Furthermore, they are also developing and using more imaging studies with less or no radiation exposure compared to the typical CAT scan.

“At present, however, the only way to exclude cancer of the bladder is a cystoscopy,” Raman said. “If your scan looks OK and you skip that, you could miss a diagnosis. The ideal situation is to realize that blood in the urine is something significant and seek medical care before you end up in the ER with a problem that is really bad.”

Experts from Penn State Hershey Cancer Institute will answer questions about urologic cancers – such as prostate, bladder, kidney and testicular cancer – during a live web chat on Tuesday, Sept. 8 from 1 to 2 p.m. at To submit questions early, visit

The Medical Minute is a weekly health news feature produced by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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