Bladder

Whether blood in the urine comes with other complaints matters a great deal: burning when urinating, flank and lower back pain, groin pain, high fever, nausea and vomiting. In such cases, cystitis, kidney inflammation, stone disease, prostate enlargement or prostate cancer are considered first; however, the possibility of a kidney or bladder tumor must not be forgotten.

Pain resembling renal colic alongside blood in the urine does not always mean a stone: with a bleeding kidney tumor, blood clots can block the ureter and cause colic-like pain. That is why, if there has been blood in the urine, you should have a medical examination rather than simply assuming it is a stone. That said, kidney cancer often causes no symptoms at all and is found by chance during tests done for another reason.

Traces of blood in a urine test that are invisible to the naked eye (microscopic blood) can also be the first sign of a serious disease. So if blood has appeared in your urine or in a test even once, you should consult a urologist.

Visible blood always requires a full examination — even if it is painless and happens only once, and regardless of age. Even if the ultrasound is normal, cystoscopy and imaging of the upper urinary tract (CT urography) may be needed.

Bladder cancer often shows up as blood in the urine — usually painless, with reddish urine. The initial evaluation includes a urine test and an ultrasound; these simple steps are the beginning of the workup.

However, bladder cancer cannot be ruled out with ultrasound and a urine test alone: small and flat tumors, as well as tumors of the upper urinary tract, may not be visible on ultrasound. If there has been visible blood, a camera examination of the inside of the bladder (cystoscopy) and imaging may be needed even if the ultrasound is normal.

Alongside blood in the urine, there may also be pain in the groin and above the pubic bone, frequent or urgent urination, blood clots in the urine, lower back pain, general weakness and unexplained weight loss. When the tumor spreads to other organs (metastasis), symptoms related to that organ can appear — for example, a cough or bloody sputum when it has spread to the lungs.

The grade and stage of the disease are determined through diagnostic tests, and treatment is chosen accordingly. If the tumor has not grown into the muscle layer of the bladder, transurethral resection of the bladder tumor (TURBT), performed through a cystoscope — that is, removing the tumor-bearing area through the urethra without any incisions — is possible; depending on the risk group, medication may also be instilled into the bladder after TURBT (intravesical instillation). If the tumor has grown into the muscle layer, more extensive treatment such as radical cystectomy (complete removal of the bladder) is usually required; in some cases chemotherapy before surgery is discussed, or, in selected patients, combined treatment that preserves the bladder.

Because the tumor may come back after TURBT, regular follow-up cystoscopies are needed. Radical cystectomy is major surgery: the route by which urine leaves the body is reconstructed, recovery takes a long time and it is not suitable for every patient — the decision takes into account the patient’s general health, other illnesses and personal choice.

Once treatment is complete, regular follow-up and lifestyle are equally important: regular checkups on the schedule set by your doctor, quitting smoking, maintaining a healthy weight, a diet and physical activity program based on your doctor’s advice, and a preference for natural foods.

Smoking is one of the main risk factors for bladder cancer, so quitting is especially important. Follow-up checkups make it possible to detect a recurrence or a new change at an early stage: the frequency of follow-up cystoscopies after TURBT, and of imaging and tests after radical cystectomy, is determined individually by your treating doctor.

Lifestyle changes can help reduce risk, but they do not replace follow-up checkups. If blood appears in your urine again during follow-up, see your doctor without waiting for the next scheduled checkup.

When a urinary tract infection develops, it is not right to wait for it to clear up by itself. Left untreated, the infection can spread upward to the kidneys, creating a risk of permanent kidney damage. In pregnant women, an untreated infection can lead to preterm birth; in people with chronic illnesses, the course may be more severe.

If the infection has progressed, long-term antibiotic treatment may be needed. Antibiotics should be taken only as prescribed by a doctor and until the course is finished — antibiotic treatment that is stopped early or chosen on your own promotes the development of resistant bacteria and paves the way for the infection to become chronic.

Bacteria normally live around the genitals and the anus. Sometimes they travel up the urethra and reach the bladder. Because the urethra is short in women, this route is easier to travel — which is why cystitis is more common in women. Normally the bacteria are flushed out with urine; but when more bacteria enter than are flushed out, or when the immune system is weakened, inflammation can develop in the bladder and then in the kidneys.

Contributing factors: sexual intercourse, insufficient attention to genital hygiene, holding urine for long periods, conditions that narrow the urinary tract, and the drop in estrogen levels during menopause. Treatment and prevention measures are chosen individually for each patient; timely and appropriate treatment can help prevent the condition from becoming chronic.

Chronic urinary tract infection is a common problem in women. Sometimes it takes hold in childhood and flares up from time to time in adulthood; despite attempts to treat it with antibiotics, it can go on for years. Symptoms: frequent urination, pain or burning when urinating, fever, fatigue, dark or red urine, pain in the lower abdomen and flank, nausea, and passing only small amounts of urine despite the urge.

In this situation, routine tests alone are often not enough. An accurate diagnosis may require cystoscopy and computed tomography performed in specific phases — the goal is to find the underlying cause that keeps the infection going (a stone, a narrowing, residual urine, reflux).

As for the length of treatment: acute diseases and acute syndromes can be treated in a short time, but chronic diseases sometimes require several courses. Patience is needed — without it, the treatment will not be effective either.

Results differ from patient to patient, and courses of treatment are planned individually; tests such as cystoscopy and contrast-enhanced CT have their own limitations and risks — whether they are needed is determined by the doctor.

It is a syndrome that involves sudden urges to urinate that are hard to hold back, frequent urination and waking up at night. The constant need to go to the toilet can negatively affect social life, daily plans, sleep and sex life. Before treatment begins, other causes that produce the same complaints — infection, stones, tumors — must be ruled out.

In older men, overactive bladder can occur together with enlargement of the prostate gland; that is why a prostate examination is important at this age. Treatment can be conservative (behavioral measures, medication) or surgical — a specialist determines this based on the cause of the symptoms and the patient’s general health.

Medication has side effects (dry mouth, constipation, cognitive changes in older people) and contraindications; no single method is right for everyone.

It is a condition seen mainly in women, involving chronic pain and pressure in the bladder area and sometimes pelvic pain. The pain increases as the bladder fills and eases after it empties. Although the symptoms resemble a urinary tract infection, a urine culture usually does not confirm an infection — it is precisely the persistence of symptoms despite a negative culture that suggests this diagnosis.

In interstitial cystitis, simple treatments are often not enough, and treatment differs from patient to patient; expecting quick results is not realistic. If the complaints recur or do not go away, you should see a specialist with experience in this area.

The diagnosis is made by exclusion — infection, stones and tumors must be ruled out first. The effect of treatment varies from person to person.

Prostate and incontinence medications, which are widely used in urology, can cause adverse effects when taken together with certain other drugs — steroids, heart medications and antiarrhythmics; in older patients, this combination can contribute to a decline in memory and cognitive function. Anticholinergic drugs are contraindicated in patients with raised eye pressure (glaucoma).

Urinary incontinence is not only related to age: urinary tract infections, poorly controlled diabetes, atrophic vaginitis in women, a person’s mental state and other medications being taken can also be causes. That is why the patient’s age, other health conditions and full medication list must be assessed before anything is prescribed.

Do not stop a prescribed medication or change its dose without talking to your doctor; if you notice side effects, tell your treating doctor.

There is no universal test — no single method that can provide a specific diagnosis. Each disease has its own specific test. In neurogenic bladder dysfunction, neither MRI, CT nor ultrasound will make the diagnosis; in such cases, urodynamic testing is needed.

With blood in the urine, more extensive tests are used: not only CT and MRI, but also cystoscopy, in which a camera is passed into the bladder to see what is going on inside — whether there is a mass, a stone or inflammation. The main principle is this: instead of going through every test, needed or not, the specific test that matches the complaint should be chosen.

Imaging methods (ultrasound, CT, MRI) show the structure of the urinary tract, while urodynamic testing assesses how the bladder works (its function). Urodynamic testing requires a catheter and may cause brief discomfort.

The source of blood or protein in the urine may be not the bladder but the kidney’s filters — for example, in glomerulonephritis. This is a nephrological rather than a urological disease: if the urological examination finds no cause in the urinary tract and tests show changes that originate in the kidney, the patient is referred to a nephrologist.