Understanding and treating haematuria

In his latest online article, Mr Philip Charlesworth gives us his insights into haematuria. He talks about the main treatment for haematuria, how its treated if caused by a urinary tract infection (UTI), how its treated if caused by kidney stones and how its treated if caused by bladder cancer.

What is the main treatment for haematuria?

Haematuria, or blood in the urine, can be categorised as visible or non-visible. Non-visible haematuria is detectable only through medical tests, while visible haematuria is apparent in the urine. Both types are taken seriously by doctors as they may indicate serious issues in the urinary tract. The likelihood of finding sinister pathology is around 5% for non-visible haematuria and 20% for visible haematuria, varying based on factors like age and risk factors.

Elderly individuals, heavy smokers, or those with a family history of bladder cancer face higher risks. Even in younger individuals with recent infections, there's a need for investigation. Tests for haematuria include scans (ultrasound or CT scans) to examine kidneys for stones or cancers, and urine tests to rule out infection. A flexible cystoscopy, visual inspection of the bladder lining, is also conducted. Current scans are limited in assessing the bladder lining, necessitating visual inspection, though promising new tests may emerge.

If haematuria is detected, especially visible blood, an urgent referral is made for further investigation. This can be within the NHS or, for those with insurance, through a urologist for the same tests in the independent sector.

What are the treatments?

The choice of treatment depends on the specific diagnosis, highlighting the importance of obtaining an accurate diagnosis. For instance, if diagnosed with kidney stones, consulting with a specialist in stone management is crucial for tailored treatment. Similarly, a diagnosis of kidney cancer necessitates the expertise of a specialist in kidney cancer to determine whether surgical removal, either through traditional or robotic methods, is required.

While some cases involve minor issues like cysts that require ongoing monitoring through serial scans, others, especially in my specialisation of bladder cancer, may be superficial and can be treated with a relatively straightforward operation. Ongoing surveillance and liquid treatments applied directly to the bladder may be recommended to prevent recurrence and further growth. However, a subset of bladder cancers is more aggressive, infiltrating deeper parts and posing a risk of metastasis.

How is haematuria treated if it is caused by a urinary tract infection?

Blood in the urine is often linked to urinary tract infections (UTIs), more common in women, which can damage the bladder lining and result in visible blood. UTIs, frequently associated with factors like sexual activity or postmenopausal hormonal changes, have varying treatment approaches based on severity and recurrence. Options range from short courses of antibiotics to interventions strengthening the bladder lining, including vaccinations to boost immunity. Tests for investigating haematuria may uncover benign conditions like recurrent UTIs, highlighting the need for a comprehensive diagnostic evaluation.

How is this treated if it is caused by kidney stones?

If haematuria is caused by kidney stones, the associated pain from stone movement can be severe. Small stones passing through the ureter are diagnosed through a CT scan. Treatment options for large kidney stones include shockwave treatment, laser operations, or keyhole surgery. Collaboration with skilled kidney surgeons is essential. For bladder stones, endoscopic procedures or keyhole removal may be necessary. Stones in the bladder can be linked to an enlarged prostate, requiring simultaneous intervention. It is crucial to obtain a clear diagnosis and consult with a urology specialist to determine the most suitable treatment.

How is it treated if it is caused by bladder cancer?

If blood in the urine is attributed to bladder cancer, diagnosis is typically done through a flexible cystoscopy, utilising a small camera to visualise the bladder lining. About 80% of bladder cancers are small and superficial, allowing for removal through a general anaesthetic operation that shaves away the affected area. The remaining 20% are more serious, invading deeper muscle areas, termed muscle-invasive or locally advanced bladder cancers. These cases require aggressive treatment, including chemotherapy, radiotherapy, and sometimes extensive surgery. Removal of the bladder using robotic surgical techniques, an area of expertise, has demonstrated improved safety and outcomes in recent years, as found by significant randomised controlled trials.

Mr Philip Charlesworth is an esteemed urologist with over 20 years of experience. You can schedule an appointment with Mr Charlesworth on his Top Doctors profile.