Microscopic hematuria: Is it threat?

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Urine examination is a simple one of the most common in the medical investigations, and it always included in the health checkup package program. Microscopic hematuria is one condition which can possibly be a result from urine examination. Today we will discuss about this issue.

Microscopic hematuria is defined for at least 7 days presenting 3 red blood cells/HPF in 2 consecutive urine examination tests. Where the bloods coming from? And is it threat? That is the most and routinely questions that patients asked me while they are in my urology clinic.  First of all, I’m going tell you that, it is fine! Don’t be worry! Mostly it won’t cause any serious problem. If that is a problem, you will see your urine very redness with your bare eyes, not invisible like this, but anyway, a positive red blood cell finding in urine examination, we must do a further investigation to ensure that everything is alright.

All possible bleeding locations which can lead to microscopic hematuria.

1. Contamination – I must say that most commonly etiology in Microscopic hematuria is the contamination sampling during urine collection method for example
   • Incorrect mid-stream urine collection
   • Test urine examination during the menstrual period (Women patients)
2. Kidney – Kidney stone, kidney mass, kidney infection or non-surgical related kidney diseases
3. Ureter – Ureteral stone, ureteral tumor
4. Bladder – Bladder stone, bladder tumor, bladder infection
5. Prostate (Men patients) – Prostate disease, prostate cancer, prostate infection
6. Urethra – Urethral stone, urethral infection

The proper methodology in order to make clear in term of etiology of the Microscopic hematuria is the accuracy imaging. CT scan is the definite imaging to answer this kind of problem. When we found the positive clue from CT scan, then we will follow the protocol on each suspicious diagnosis. In the other hand, if we found nothing, we can ensure the patient that the symptom is fine, and it required to have the annual simple urine examination is all. The recommendation from American Urology Association guideline in 2020, suggest that we can let go the patient free from the annual following up program if the urine examination turn to negative finding. See you guys on the next content!

Any questions, you can feel free to discuss with me.