Blood in the Urine — What Happens Next

Understanding your condition

Haematuria means blood in the urine. It can be:

• Visible (macroscopic) haematuria: Urine that appears pink, red, or brown — noticeable with the naked eye. This always warrants prompt investigation.
• Non-visible (microscopic) haematuria: Blood detected only on a urine dipstick or laboratory test, with no visible discolouration. This also requires investigation when persistent.

Haematuria is a symptom, not a diagnosis in itself. In many cases a benign cause is found — such as a urinary tract infection, kidney stone, or, in men, an enlarged prostate. However, because haematuria can occasionally be the first sign of a bladder or kidney tumour, it is important that it is fully investigated even if you feel perfectly well and have no other symptoms.

What this means for you

Finding blood in the urine is understandably worrying. The purpose of investigation is to identify or exclude significant underlying causes as efficiently as possible. You are likely to be referred for a combination of the following:

• Urine tests: Urine microscopy and culture (to look for infection, abnormal cells), and urine cytology (looking for cancer cells shed from the urinary lining).
• Blood tests: Kidney function, full blood count, and PSA (for men) are routinely checked.
• Imaging: A CT urogram is the standard investigation — it provides detailed images of the kidneys, ureters, and bladder and can detect stones, tumours, and structural abnormalities. An ultrasound may be used in some circumstances.
• Flexible cystoscopy: A telescope examination of the bladder and urethra. This is one of the most important investigations for haematuria as bladder tumours can be invisible on imaging but clearly visible endoscopically. It is performed with local anaesthetic gel, takes 5–10 minutes, and is well tolerated.

Monitoring and follow-up

The timeline and follow-up depends on the findings:

• No cause found: Many patients — particularly younger women — have haematuria investigated fully with no cause identified. This is called idiopathic haematuria and often resolves. A follow-up urine check at 6–12 months may be recommended.
• Infection confirmed: Treated with appropriate antibiotics; a repeat urine check is arranged to confirm clearance.
• Stone confirmed: Investigation and management of the stone (see separate stone leaflet).
• Bladder tumour found: Prompt surgical treatment (TURBT) is arranged (see separate TURBT leaflet).
• Renal tumour found: Referral to the appropriate specialist pathway.

Even after investigation, if visible haematuria recurs, Dr Hadjipavlou should be informed promptly — a single previous episode of haematuria investigated with normal results does not prevent a new tumour from developing.

Questions to ask your doctor

• What investigations are you recommending and why?
• What is the likely cause of my haematuria based on my history?
• How long will the investigation process take?
• When will I receive the results, and what happens if the tests are normal?
• Is there anything I should watch for while the investigations are being arranged?
• Does my haematuria require any immediate treatment?
• What follow-up will I need after investigation?