Urology · University Urology, PC · Knoxville, TN
Blood in Urine (Hematuria)
Finding blood in your urine can be alarming. While there are many causes — most of them benign — hematuria always warrants evaluation by a urologist to rule out serious underlying conditions including bladder cancer, kidney cancer, and kidney stones.
Understanding Hematuria
What Is Hematuria?
Hematuria means blood is present in the urine. It can be visible to the naked eye (gross hematuria — pink, red, or brown urine) or detected only on a urine test (microscopic hematuria). Both types require evaluation.
A single episode of gross hematuria — even if it resolves on its own — should be evaluated. Blood in the urine that comes and goes does not mean the cause is benign.
Gross Hematuria
Urine that appears pink, red, or cola-colored. Visible to the naked eye. Even a single episode requires prompt urologic evaluation regardless of whether it resolves.
Microscopic Hematuria
Blood detected on urinalysis that is not visible. Defined as 3 or more red blood cells per high-power field. Requires evaluation when found on two or more urine tests, or once in a high-risk patient.
Do not assume a benign cause without evaluation
Blood in the urine is one of the most common presenting symptoms of bladder cancer and kidney cancer. Bladder cancer is the 4th most common cancer in men. Up to 20% of patients with gross hematuria have a urologic malignancy. Evaluation is always indicated.
Common Causes
What Causes Blood in Urine?
Bladder Cancer
The most important diagnosis to exclude. Gross hematuria is the most common presenting symptom. Painless hematuria in a smoker or anyone over 50 requires urgent cystoscopy.
Kidney Cancer
Renal cell carcinoma can cause hematuria, particularly as tumors grow and involve the collecting system. Often discovered incidentally on imaging ordered for hematuria workup.
Kidney Stones
Stones irritating the ureter or kidney collecting system commonly cause hematuria, often with flank pain. CT urogram identifies stones and their location.
Urinary Tract Infection
UTIs are a common cause, especially in women. Hematuria that persists after successful UTI treatment requires further workup.
Enlarged Prostate (BPH)
An enlarged prostate can cause blood in the urine in men. Prostate cancer should also be excluded in this setting.
Other Causes
Strenuous exercise, certain medications (blood thinners), kidney disease, trauma, and radiation cystitis can all cause hematuria.
What to Expect
How Hematuria Is Evaluated
Urine tests
Urinalysis and urine culture to confirm blood and rule out infection. Urine cytology to look for abnormal cells in high-risk patients.
CT urogram
A CT scan with and without contrast that images the kidneys, ureters, and bladder. The most sensitive imaging study for identifying kidney masses, stones, and urothelial tumors.
Cystoscopy
A direct camera examination of the bladder and urethra. Essential for ruling out bladder cancer in patients with hematuria. Performed in the office under local anesthetic in 10–15 minutes.
Further evaluation if needed
If a mass or lesion is identified, additional imaging (MRI, CT chest) and biopsy may be recommended. Most patients complete evaluation without requiring further procedures.
Our Specialists
Who Evaluates Hematuria at University Urology
All University Urology physicians evaluate hematuria. Complex cases involving bladder or kidney cancer are managed by our fellowship-trained urologic oncologists.
Common Questions
Frequently Asked Questions
The blood in my urine went away on its own. Do I still need to be seen?
Yes. Hematuria that resolves spontaneously does not mean the underlying cause is gone. Bladder cancer characteristically causes intermittent hematuria. A single resolved episode still requires evaluation.
My doctor said it was probably a UTI. Is that the end of it?
If hematuria resolves completely after UTI treatment, no further workup may be needed in a young, low-risk patient. If it persists after treatment, or if you are male, over 50, or a current or former smoker, urologic evaluation is indicated regardless.
Is cystoscopy painful?
Most patients find it tolerable. Topical anesthetic is used. The procedure takes 5–10 minutes and you can drive yourself home. See our cystoscopy preparation page for full details.
Do I need a referral?
No referral is required to be seen at University Urology. Call or message us directly to schedule your evaluation.
Blood in Your Urine? Don\'t Wait.
Hematuria always warrants evaluation. Our urologists offer prompt, thorough workups across 11 East Tennessee locations.