Haematuria Should I be worried? Haematuria There are two types of haematuria: visible and nonvisible. Visible (gross/frank) haematuria is when your urine appears red. This is a more worrisome condition than non-visible haematuria as there is an associated risk of cancer within the urinary tract of up to 22-32%. Visible haematuria warrants more detailed investigation due to the higher risk of detecting malignancy within the urinary tract. Non-visible (microscopic) haematuria is when red blood cells are seen under a microscope in your urine. This is defined as ≼ 3 red blood cells per high power field in an appropriately collected urinary sample. It is a relatively common condition, affecting 2-30% of the population, with higher rates
in males aged > 60 years old and ex/current smokers. There is an estimated 3-5% risk of cancer within the urinary tract with microscopic hematuria. However, do note that blood seen on a urine dipstick does not mean that it is haematuria and warrants microscopic examination of the urine for confirmation.
Mild haematuria
Haematuria with blood clots
Large blood clots can cause difficulty with urination & result in inability to pass urine (acute retention of urine)
What can cause Haematuria? The causes of haematuria include: • Urinary tract infection • Urinary stones • Prostate enlargement • Benign Prostate Enlargement (BPE) • Cancers of the urinary tract What tests are required? Visible Haematuria A urine culture is required to check for the presence of a urinary infection. Detailed imaging in the form of Computed Tomography (CT) Urography or Magnetic Resonance Imaging (MRI) is required to look for the cause. A flexible cystoscopy is required for all, especially those aged 35 years and above, as imaging may not detect small bladder tumours.
Non-visible Haematuria Your doctor will discuss with you regarding suitable imaging options. These can include an ultrasound of the kidneys, ureters and bladder, an X-ray, an Intravenous Urography (IVU) or a Computed Tomography (CT) scan. An IVU involves a series of X-ray images taken while a special dye (contrast) is given through a drip and passed out in the urinary system. A flexible cystoscopy is highly recommended for all with risk factors for cancers of the urinary tract. These risks include smoking history, certain chemical exposures and previous radiation to the pelvis.
Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.
URO.PE.08.1020