Why blood in urine should not be ignored

Written by: Mr Vibhash Mishra
Edited by: Laura Burgess

Blood in the urine, or haematuria, can be the symptom of a number of different underlying conditions, such as a urinary tract infection, kidney stones or an enlarged prostate (BPH) in men. However, having your GP or specialist determine a correct diagnosis is crucial in catching a more serious condition such as bladder cancer before it further progresses.

Here, one of our expert urologists Mr Vibhash Mishra shares an experience that he recently had with one of his patients who was receiving bladder cancer treatment under his care. Unfortunately, the patient did not have a cystoscopy soon enough, which may have picked up on the disease in its earlier stages.

What happened with your patient recently and their bladder cancer treatment?

The other day I operated on a man with a very nasty looking bladder cancer. He was obviously very upset and wanted me to speculate if cancer could have been there when he first saw blood in urine nearly 18 months ago and whether it could have progressed in this time.

It is anybody’s guess but it cannot be denied that the answer to both questions may well be ‘yes’. It is possible that he had cancer when he first saw blood in urine and that it could have become more extensive in the time he waited for surgery.

What should someone do if they see blood in their urine?

The sight of blood in urine or blood from anywhere in the body can be scary and people should run to seek help at once. It is important for people to be aware that blood from any orifice of the body should be taken seriously as it can be a sign of cancer.

Why do you think there could be a delay in a bladder cancer diagnosis?

The reason lies in the common tendency on the part of doctors to prescribe antibiotics as soon as someone presents to them with haematuria. And not wrongly so either. After all, urinary infection is indeed the commonest cause of haematuria.

Therefore the patients get antibiotics and haematuria more often than not stops lending credence to the belief that it must have been an infection. But herein lies a clinical trap. Haematuria would probably have stopped anyway because even in the presence of cancer, blood in urine is usually seen only intermittently. By the time it has been ‘treated’ repeatedly with antibiotics, it may be quite late.

How should doctors and patients avoid the misdiagnosis of bladder cancer?

They do so by being aware of the intermittent nature of haematuria, by remembering that haematuria associated with infection should usually be painful as opposed to cancer-haematuria which is usually painless.

They should send a sample of urine to the laboratory for culture before starting the antibiotic and questioning their diagnosis if the result shows no infection, by being open to considering many different possibilities.

If you’re worried about blood in your urine, you can book an appointment with Mr Mishra here for him to guide you with an expert diagnosis of the underlying cause.

By Mr Vibhash Mishra

Mr Vibhash Mishra is a leading consultant urological surgeon and Clinical Lead for Lower Urinary Tract Services at Royal Free Hospital, London. His main interests are urinary incontinence and bladder dysfunction, but he also looks after patients with haematuria, bladder tumour, peno-scrotal problems, prostate disorders, urethral stricture, lower urinary tract symptoms and recurrent UTI

Mr Mishra is closely involved in education and research. He serves the UCL Medical School as the lead for undergraduate urology teaching. He has published papers in peer-reviewed journals, written book chapters and been a principal investigator for multi-centre research projects. 

He qualified and obtained his Masters in General Surgery in India prior to completing a six-year rotation in urology in London including the last two years as a fellow in female and reconstructive urology at the prestigious Institute of Urology at UCLH, London.

He believes the practice of medicine has to be a blend of art and science based on a scientific foundation and humane face. Professionalism must not be allowed to overtake the personal touch and care must be provided with gentleness, sensitivity and respect. He considers his compassion, effective listening skills and affability as his assets. He is calm and unhurried and explains the pros and cons of any recommended treatment at length in a comprehensible language. Consequently, his patients find it easy to strike an instant rapport with him and leave the consultation knowing exactly how to contact him directly in case of any problems.

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