The following symptoms and complaints may occur together with hematuria (blood in urine):
Leading symptoms
- Microhematuria (= presence of blood in the urine (> 5 erythrocytes/µl)).
- Macrohematuria – in this form you can see a red coloration of the urine.
Associated symptoms
- Dysuria – pain during urination
- Pollakisuria – urge to urinate frequently without increased urination.
- Increased urination
- Recurrent hematuria
- Abdominal pain (abdominal pain)
- Shock symptomatology with low blood pressure (< 100 systolic) and rapid pulse (< 100 beats per minute) (in the presence of a major hemorrhage)
Risk factors requiring advanced diagnostic testing
- Higher age
- Male gender
- Tobacco use
- Macrohematuria
- Repeatedly detected microhematuria
- Dysuria or urge symptomatology.
- Chronic urinary tract infection
- History of urological disease (eg, tumor disease).
- Condition after radiotherapy (radiatio) of the small pelvis.
- Exposure to (occupational) noxious agents – s. U. Urinary bladder carcinoma (bladder cancer) or hypernephroma (renal cell carcinoma)/environmental pollution – intoxications (poisonings).
- Medications: Analgesic abuse, chemotherapeutic agents, carcinogens (without further details).
Warning signs (red flags)
- Anamnestic information:
- Age > 60 years + cystitis (especially if refractory to therapy) → think of: Urinary bladder carcinoma
- Painless hematuria, especially macrohematuria (visible blood in the urine) → think: malignant (malignant) process (carcinoma of the urinary bladder, renal cell carcinoma, prostate carcinoma).
- Painful hematuria → think of: Uro- or nephrolithiasis (urinary stone or kidney stone disease) and renal cell carcinoma (onset with painless bleeding, then renal colic due to discharge of blood coagula in the ureter (ureter)).
* Every third patient with macrohematuria has cancer. Most often, patients are older than 70 years. In the majority of cases, urothelial carcinoma is present. The second most common diagnosis is prostate carcinoma.
