Hematuria (II)

This is the 2993th article of Da Yi Xiao Hu

Hematuria refers to blood in the urine. If the amount of bleeding is large, it is visible to the naked eye, which is called macroscopic hematuria. If the amount of bleeding is small, the blood is often not found by the naked eye and must be found under a microscope, which is called microscopic hematuria. If urination is done soon after bleeding, the urine may be bright red; if the bleeding stays in the bladder for a period of time before being discharged, it may become dark brown; in severe bleeding, there may be blood clots in the urine. During urine testing, if the red blood cell count exceeds 3 in each high-power microscopic field of view, it is clinically diagnosed as hematuria. Hematuria is a common symptom of urinary system diseases, and certain diseases outside the urinary system can also cause hematuria. Earlier, it was discussed that red urine is not necessarily hematuria, and common urological and non-urological diseases that cause hematuria.

Painless hematuria in urinary tract tumors

Hematuria is a common symptom of urinary system tumors, especially painless gross hematuria is often a signal of urinary system tumors. The most important symptom of bladder tumors is intermittent painless gross hematuria throughout the whole process, that is, hematuria sometimes appears and sometimes does not, sometimes more and sometimes less, hematuria can last for several days, or it may not appear for a long time. Patients often mistakenly believe that the disease has been cured. The amount of bleeding and the duration of hematuria have a certain relationship with the malignancy, size, range and number of the tumor, but they are not necessarily proportional. Hematuria can also occur in renal pelvic cancer, ureteral cancer, and kidney cancer. Some patients will have renal colic due to small blood clots. Especially for people over 40 years old, when painless gross hematuria occurs, they should go to the hospital for a systematic examination to avoid missed diagnosis.

Urinary tract infection can also cause hematuria

Hematuria is not a symptom unique to urinary tract tumors. Urinary tract infections such as common acute bacterial cystitis can also cause hematuria. Urinary tract infections cause congestion and edema of the urinary tract mucosa, which can easily cause bleeding. Urinary tract infections not only cause microscopic hematuria, but also gross hematuria when the infection is severe. According to statistics, about 5% of patients with urinary tract infections have gross hematuria as the main clinical manifestation, accompanied by urinary tract irritation symptoms such as frequent urination, urine tests, and urinary pain. In addition, hematuria can also be seen in pyelonephritis, urethritis, prostatitis, etc.

Hematuria is also a common symptom of urinary stones

Urinary stones cause hematuria mainly because the stones move in the kidney, ureter or bladder, causing mechanical damage to the urinary tract mucosa and bleeding, resulting in hematuria. Sometimes urinary stones can also cause urinary tract infection, causing inflammatory congestion and edema of the urinary tract mucosa and causing hematuria. Common ureteral stones can cause hematuria and renal colic, which is sudden pain on one side of the waist and abdomen. When hematuria is accompanied by renal colic, it may be a signal of ureteral stones.

Author: Shanghai Fifth People's Hospital Affiliated to Fudan University

Wang Wei, deputy chief physician

For more medical popular science content, please see "From "Unspeakable Secrets" to "Clear Mind" - Notes on Urology Practice" http://spu.dangdang.com/1557813295.html (edited by Wang Wei, Fudan University Press).

In recent years, with the improvement of people's living standards and the aging trend of the social population, the prevalence of urinary system diseases has gradually increased, often bringing inconvenience and pain to patients' daily life and work. Due to its privacy characteristics, urinary system diseases are often regarded as "unspeakable secrets", which are difficult for patients to talk about, so they fail to seek medical treatment in time; some patients do not have enough understanding and knowledge of such diseases, resulting in missed treatment opportunities; and there are also false advertisements and pseudo-popular science in the media, which mislead patients and cause huge losses and harm. Therefore, it is necessary to understand the diagnosis and treatment knowledge of common urinary system diseases, so that early diagnosis and early treatment can be carried out after the signs of the disease are found, and it can also help prevent the occurrence of the disease. The author popularizes the diagnosis and treatment knowledge of common urinary system diseases (such as benign prostatic hyperplasia, urinary stones, urinary tract infections, urinary system tumors, urinary system malformations, etc.) through the narration of clinical personal experience, aiming to help readers prevent and diagnose and treat common urinary system diseases at an early stage. This book is rich in content, covering common and frequent diseases of the urinary system. The content combines the medical progress in this field and introduces valuable new diagnosis and treatment technologies that have emerged in recent years.