what would make a male pee blood

Hematuria: Etiology and Evaluation in Males

Definition

Hematuria refers to the presence of erythrocytes in the urine. It is classified as either gross (visible) or microscopic (detectable only via laboratory testing). Evaluation is warranted to determine the underlying cause.

Etiologies

Renal Causes

  • Glomerular Disease: Conditions such as glomerulonephritis, IgA nephropathy, and Alport syndrome can lead to hematuria, often accompanied by proteinuria.
  • Tubulointerstitial Nephritis: Inflammation of the kidney tubules and surrounding tissue can cause hematuria.
  • Renal Cell Carcinoma: Malignant tumors of the kidney may present with hematuria.
  • Renal Cysts: Simple or complex cysts may occasionally bleed, resulting in hematuria.
  • Nephrolithiasis: Kidney stones can cause hematuria due to physical trauma to the urinary tract.
  • Trauma: Direct injury to the kidney can result in hemorrhage into the urinary system.

Ureteral Causes

  • Ureteral Stones: Similar to kidney stones, ureteral stones can cause hematuria.
  • Ureteral Tumors: Rare tumors of the ureter may present with bleeding.
  • Ureteral Strictures: Narrowing of the ureter can lead to inflammation and bleeding.

Bladder Causes

  • Bladder Cancer: A common cause of hematuria, particularly in older males and smokers.
  • Cystitis: Inflammation of the bladder, often due to infection, can cause hematuria.
  • Bladder Stones: Similar to kidney and ureteral stones, bladder stones can cause hematuria.
  • Trauma: Injury to the bladder can result in hemorrhage.
  • Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate can irritate the bladder and urethra, sometimes leading to hematuria.

Prostatic Causes

  • Benign Prostatic Hyperplasia (BPH): As mentioned above, BPH can lead to hematuria.
  • Prostatitis: Inflammation of the prostate gland, often due to infection.
  • Prostate Cancer: Malignant tumors of the prostate can occasionally cause hematuria.

Urethral Causes

  • Urethritis: Inflammation of the urethra, often sexually transmitted, can cause hematuria.
  • Urethral Strictures: Narrowing of the urethra can lead to inflammation and bleeding.
  • Urethral Trauma: Injury to the urethra, such as from catheterization or instrumentation.

Other Causes

  • Medications: Certain medications, such as anticoagulants, can increase the risk of hematuria.
  • Strenuous Exercise: Vigorous physical activity can sometimes cause transient hematuria.
  • Infections: Systemic infections can rarely cause hematuria.
  • Bleeding Disorders: Conditions that affect blood clotting can increase the risk of hematuria.

Evaluation

A thorough evaluation is necessary to determine the cause. This typically includes:

  • History and Physical Examination: Detailed questioning about symptoms, medical history, and risk factors, as well as a physical assessment.
  • Urinalysis: Examination of the urine to detect red blood cells, white blood cells, bacteria, and other abnormalities.
  • Urine Culture: To identify any bacterial infection.
  • Cytology: Microscopic examination of urine cells to detect abnormal cells (e.g., cancer cells).
  • Imaging Studies:
    • CT Urogram: Computed tomography scan to visualize the kidneys, ureters, and bladder.
    • Renal Ultrasound: Ultrasound imaging of the kidneys.
  • Cystoscopy: Visual examination of the bladder and urethra using a cystoscope.

Management

Treatment depends on the underlying cause. Management may include antibiotics for infections, medication for BPH, lithotripsy for kidney stones, or surgery for tumors.