Rigi10™ Malleable Penile Prosthesis
Also Known As
Blood in urine, bloody urine, erythrocyturia, microhematuria (for microscopic hematuria), gross hematuria, macroscopic hematuria, frank hematuria, dipstick hematuria
Definition
Hematuria refers to the presence of blood cells in the urine.1 It is categorized into two main types: gross hematuria, where blood is visible to the naked eye, turning urine pink, red, or cola-colored; and microscopic hematuria, where blood cells are only detectable under a microscope during laboratory examination.2 Gross hematuria occurs when there is enough blood in the urine to change its color, while microscopic hematuria involves such small amounts of blood that it can only be seen with a microscope when a lab tests the urine.3
The medical threshold for microscopic hematuria is typically defined as ≥3 red blood cells per high-power field (RBC/HPF) on microscopic evaluation of a single urine specimen.4 This finding may be incidental or symptomatic, and can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate (in men), or urethra.5 Hematuria serves as an important clinical indicator that warrants appropriate evaluation, as it may signal underlying conditions ranging from benign causes to serious diseases including urinary tract malignancies.6
Clinical Context
Hematuria is a common finding in clinical practice, with microscopic hematuria affecting an estimated 2% to 31% of the general population.1 It serves as a critical diagnostic indicator that requires appropriate evaluation due to its association with potentially serious underlying conditions.
The clinical approach to hematuria begins with confirming its presence. For microscopic hematuria, this involves microscopic urinalysis demonstrating ≥3 red blood cells per high-power field.2 For gross hematuria, visual confirmation is sufficient, and any episode of gross hematuria in an adult warrants consideration of urgent urologic evaluation given the relatively high probability of cancer or other clinically significant conditions (>10% in most studies).3
Risk stratification is essential in the clinical management of hematuria. Patients should be classified based on their risk of genitourinary malignancy, with factors including:4
- Age (higher risk in those over 50)
- Sex (higher risk in males)
- Smoking history
- Occupational exposures to chemicals or dyes
- History of gross hematuria
- Degree and persistence of microscopic hematuria
The diagnostic evaluation typically includes cystoscopy (endoscopic examination of the bladder) and upper tract imaging, with the specific approach tailored to the patient’s risk profile.5 This risk-based strategy helps balance the benefits of detecting significant pathology against the potential harms of unnecessary testing.
Common causes of hematuria include urinary tract infections, kidney stones, benign prostatic hyperplasia, kidney disease (particularly glomerulonephritis), and urinary tract cancers (bladder, kidney, prostate, and urethral cancers).6 Less common causes include medications (such as anticoagulants, certain antibiotics, and pain relievers), strenuous exercise, and inherited conditions like sickle cell disease.7
Treatment depends entirely on the underlying cause, ranging from antibiotics for infections to surgical intervention for stones or malignancies. Even when initial evaluation is negative, patients with persistent hematuria may require follow-up testing, as some serious conditions may not be immediately apparent.8