Hematuria (Blood in the Urine)

Hematuria refers to the presence of blood in the urine. It may be visible (gross hematuria), where the urine appears pink, red, or brown, or microscopic, where blood is only detected on laboratory testing.

While hematuria is sometimes caused by minor issues such as infection or exercise, it can also be an early sign of more serious conditions, including kidney stones, enlarged prostate, or cancers of the urinary tract. For this reason, hematuria should always be evaluated carefully, even if it occurs only once.

At The Medical Group of New Jersey, our urology specialists provide a thorough, evidence-based evaluation to identify the cause of hematuria and ensure timely, appropriate care.

Symptom Onset & Initial Evaluation

Hematuria may present in different ways, and not all patients experience additional symptoms.

Common presentations include:

• Visible blood in the urine (pink, red, or cola-colored)
• Urine that appears normal but shows blood on testing
• Blood associated with urinary symptoms such as burning, urgency, or frequency
• Blood accompanied by flank pain (suggesting kidney stones)

Some patients have no symptoms at all, and hematuria is discovered during routine testing, making evaluation especially important.

Evaluation

During your visit, your urologist will take a detailed and thoughtful approach to understand possible causes.

This typically includes:

• Reviewing when the blood was first noticed and whether it was persistent or intermittent
• Discussing associated symptoms such as pain, urinary changes, or fever
• Reviewing medications (e.g., blood thinners)
• Assessing risk factors such as smoking history or occupational exposures
• Evaluating personal and family history of kidney or bladder conditions

A physical exam may include abdominal, flank, and prostate evaluation (in men).

The goal of this initial step is to determine whether hematuria is likely due to a temporary condition or requires more in-depth evaluation.

Diagnosis & Risk Assessment

Because hematuria can have many causes, evaluation is comprehensive and systematic to ensure nothing is missed. Tests may include:

Urine Testing

• Urinalysis: Confirms the presence of blood and checks for infection or protein
• Urine culture: Identifies bacterial infection when suspected
• Urine cytology (in select patients): Screens for abnormal or cancerous cells

Blood Tests

• Creatinine and BUN: Evaluate kidney function
• Complete blood count (CBC): Assesses for anemia or signs of infection
• Additional labs may be ordered if systemic or kidney-related causes are suspected

Imaging Studies

• CT urogram: The most comprehensive test to evaluate kidneys, ureters, and bladder
• Ultrasound: May be used in lower-risk patients or when radiation should be minimized

Direct Visualization

• Cystoscopy: A small, flexible camera is inserted through the urethra to directly examine the bladder and urethra. This is a key test for identifying bladder abnormalities, including tumors or inflammation

Risk Assessment

Your urologist will assess your individual risk to guide evaluation and follow-up, including:

• Age and gender
• Smoking history
• Occupational exposures (e.g., chemicals, dyes)
• Severity and persistence of hematuria
• Associated symptoms (pain, weight loss, urinary changes)

This risk-based approach ensures that serious conditions are identified early while avoiding unnecessary testing when appropriate.

Treatment & Management

Treatment depends entirely on the underlying cause identified during evaluation.

Common Causes & Treatments

• Urinary tract infection (UTI): Treated with targeted antibiotics
• Kidney stones: Managed with hydration, medication, or procedures depending on size and location
• Benign prostatic hyperplasia (BPH): Treated with medications or procedures to improve urine flow
• Inflammation or irritation: Managed with medications and lifestyle adjustments

When a Serious Cause Is Identified

• Bladder or kidney tumors: Managed with coordinated care, including urology, oncology, and surgical teams
• Kidney disease: May involve collaboration with nephrology

Your care team will clearly explain findings and guide you through next steps with a focus on both effectiveness and reassurance.

Monitoring & Follow-Up

Follow-up care is essential, even when initial evaluation is reassuring.

Your urologist may recommend:

• Repeat urine testing to confirm resolution
• Periodic monitoring if no cause is found
• Ongoing surveillance for higher-risk patients
• Follow-up imaging or cystoscopy when indicated

This step ensures that any evolving condition is detected early.

Prognosis & Preventive Care

The prognosis depends on the underlying cause, but in many cases, hematuria is treatable, especially when evaluated early.

Even when no serious condition is identified, monitoring provides peace of mind and protects long-term health.

At The Medical Group of New Jersey, we emphasize early detection, clear communication, and coordinated care, ensuring that patients feel informed, supported, and confident throughout the evaluation process.