Haematuria may present as visible (macroscopic) haematuria, or invisible (microscopic) haematuria picked up by a urine test. This is a worrying sign and prompt investigation by a Urologist is required to rule out a sinister cause.


Haematuria is generally a sign that there is a problem somewhere in the urinary tract. The blood may be originating anywhere in the urinary tract from the kidneys, ureters, bladder, prostate or urethra.


What are the possible causes of haematuria?

There are many serious and less serious causes for haematuria:

  • Kidney cancer
  • Benign kidney disease
  • Kidney stones
  • Ureteric cancer
  • Bladder cancer
  • Bladder infection or inflammation
  • Prostate cancer
  • Benign prostate bleeding from BPH
  • Trauma
  • Urethral warts
  • Blood vessel malformation (AVM)

Sometimes no cause is found despite extensive investigation.


Macroscopic haematuria

This is visible blood in the urine which is easily recognisable. In some cases, the bleeding may be heavy and cause clots to form. Clots can block the urethra and make urination difficult. Macroscopic haematuria is more likely to have a sinister cause than microscopic haematuria. Statistically, one in four people with macroscopic haematuria will have a cancer somewhere in the urinary tract. Prompt investigation is required to exclude this possibility.


Microscopic haematuria

With microscopic haematuria, the blood is in such small amounts that it is not visible with the naked eye. It is usually picked up incidentally in a urine test performed by a GP. Statistically, microscopic haematuria is much less likely to have a sinister cause, with roughly 1 in 20 patients being diagnosed with a urological cancer. In younger patients (under 40) cancers of the urinary tract are exceedingly rare, and microscopic haematuria is nearly always benign.


What investigations do I need?

In general, the entire urinary tract needs to be examined. This usually includes:

  • A CT scan to look at the kidneys, ureters and bladder
  • A cystoscopy to look inside the urethra, prostate and bladder
  • A urine test to look for infection 
  • A urine test to look for cancer cells

In younger patients (especially young females) an ultrasound of the kidneys is usually sufficient. As the chances of a urological cancer in young females with microscopic haematuria is so low, a cystoscopy is generally not required. Microscopic haematuria in young females is almost always due to urinary infection.