1. Haematuria
Haematuria is a common condition and one which must be taken seriously.
Haernaturia is usually divided into :-
- Macroscopic (where the urine is discoloured) and
Microscopic (where the blood is found only on microscopy
examination).
Investigations of Haematuria
- Urinary examination. This must include microscopy for red and white blood cells and bacteria. The presence of any crystals, ova or parasites should be noted and culture of a mid stream specimen carried out. If schistosomiasis or tuberculosis is suspected a first void urine sample is usually requested.
Ultrasound of the urinary tract
Plain abdominopelvic radiography
- Intravenous urography

2. Spiral computerized tomography
Retrograde contrast radiography or direct inspection via the Ureteroscope. In suspected ureteric lesions.
If no abnormality is found then a flexible cystoscopy under local anaesthetic may be performed, but if either the imaging or this endoscopic examination suggests a bladder lesion the patient will require a transurethral biopsy and examination under anaesthetic for both treatment and diagnosis.

3. Causes of Macroscopic Haematuria
Renal Tumours
- The commonest primary renal tumour is renal cell carcinoma, an adenocarcinoma of collecting tubule origin. Diagnosis is made by CT scanning and treatment is by surgical excision.
- Transitional Cell carcinoma of the renal collecting system usually gives haematuria . Diagnosis may be difficult , requiring retrograde imaging and ureteroscopy. Treatment is by either local excision or, for high grade or larger lesions, nephro-ureterectomy.
- Benign renal tumours may cause both bleeding and diagnostic difficulty. They are, with the exception of the incidental and usually asymptomatic renal cyst, rare . Angiomyolipoma is a hamartomatous lesion, which may grow to great size and be associated with major haemorrhage; treatment is by radiological emobolisation or surgery, conserving normal renal tissue where possible.

4. Renal Stones
- Stone disease is very common, with concretions forming in the renal papillae, which then form a nidus for stone formation in the collecting system.. Renal stones tend to be asymptomatic but may cause haematuria by either infection or direct irritation of the mucosa. They may also cause renal pain if large enough or obstructing. Diagnosis is by imaging, usually intravenous urography. Renal stones can usually be treated by extracorporeal shock wave lithotripsy although large or complex stones may need percutaneuous or open surgical removal.
 Glomerulonephritis
Glomerulonephritis tends to present with microscopic haematuria.
 Pyelonephritis (ascending urinary tract infection)
Acute bacterial pyelonephritis results from bacteria ascending from the bladder either by direct spread (vesico-ureteric reflux) or possibly by periureteric lymphatic extension. Painless haematuria may occur but the symptom complex usually includes loin pain, fever and possibly septicaemia.

5. Papillary Necrosis
This condition occurs in diabetics and in patients with deficiencies of oxygenation, particularly sickle cell disease. It is characterized by a radiolucent filling defect on IVU
Ureteric Stones
These nearly always present with pain but may have haematuria as the only symptom. The presence or absence of obstruction and the size of the stone dictates management.
Cystitis
Typically cystitis is painful and in men is commonly associated with bladder outflow obstruction. Schistosomiasis, interstitial cystitis and drug related cystitis are rarer causes of bladder inflammation causing bleeding. Diagnosis is by urine microscopy and culture, assisted by cystoscopy. Bladder biopsies may be necessary.

6. Bladder tumours
Nearly all are transitional cell cancers, with smoking and aromatic hydrocarbon exposure being risk factors. Rarer bladder tumours include adenocarcinoma (usually arising from the urachus) and squamous cancer (associated with chronic inflammation and schistosomiasis).
Prostate tumours
- Benign prostatic hyperplasia can bleed on its own: it may also cause bacterial cystitis.
-Prostate cancer, which may cause haematuria directly or by urinary tract infection. Diagnosis is by prostatic biopsy, usually with ultrasound control.
Rare causes of haematuria
Arteriovenous malformations, tuberculosis and arteritis may all cause haematuria