31 August: Q&A with Mr Adrian Joyce

A week ago I noticed bright red blood in my urine. It happened again a few days later. It is not there every time and it is in small amounts. There’s no pain and I don’t want to bother my doctor if it’s just an infection that will clear up on its own, but I’m worried in case it’s a sign of something more serious.

Mr Adrian Joyce Consultant Urologist, Spire Leeds Hospital

Blood in the urine (haematuria) is a common problem but needs to be taken seriously, as it may be the first sign of a problem, especially in patients over the age of 40. The most common causes of haematuria include kidney or urinary tract malignancy, urinary stone disease, infection or BPH (Benign Prostatic Hypertrophy).

Studies have shown that 15-20% of patients with visible haematuria may have an underlying malignancy, and this is more likely in men, older adults and smokers. It is important to have the symptoms investigated so that any problem is detected early and appropriately treated.

The investigations usually include a repeat urine sample which may be sent for urine cytology to look for any abnormal cells in the urine, an ultrasound or CT examination of the kidneys and bladder with contrast, blood tests to check kidney function and a flexible cystoscopy which is a painless method of inspecting the lining of the bladder using a flexible telescope with local anaesthetic gel. It is important to know that many conditions do not require major surgery as most can be dealt with by minimally invasive endoscopic surgery. However, even after investigation, the problem in a large proportion of patients (approximately 60%) will remain undiagnosed, but will need follow up either by urology or GP in case of recurrence, which will require further investigation. About 10% of patients with recurrent haematuria will be found to have an underlying disorder of the kidney functional system and will be referred to a nephrologist for further diagnosis.

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Mr Adrian Joyce, Consultant Urologist, Spire Leeds Hospital, Roundhay, Leeds
Mr Adrian Joyce, Consultant Urologist, Spire Leeds Hospital

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