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Treatment in Clifton, NJ

Blood in the Urine (Hematuria)

Find the Cause, Protect Your Health

Introduction to Blood in the Urine (Hematuria)

Seeing blood in the urine can be alarming. In some patients, blood is visible and turns the urine pink, red, or brown. In others, a small amount of blood is found only on a urine test. Blood in the urine, also called hematuria, has many possible causes, ranging from urinary infection and kidney stones to prostate conditions, kidney disease, or urinary tract tumors.

At East Coast Advanced Urology in Clifton, NJ, Dr. Karl Coutinho evaluates hematuria using an individualized, risk-based approach. The appropriate evaluation depends on whether the blood is visible or microscopic, your age and medical history, smoking history and other risk factors, urinary symptoms, previous testing, and whether there is an identifiable temporary cause.

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What Is Hematuria?

Hematuria means that red blood cells are present in the urine. Gross hematuria is blood that can be seen with the naked eye. Microscopic hematuria is blood that is not visible but is identified when urine is examined under a microscope.

A positive urine dipstick alone does not establish the diagnosis of microscopic hematuria. When a dipstick shows blood, microscopic examination of the urine can confirm whether red blood cells are actually present.

Blood can enter the urine from different parts of the urinary tract, including the kidneys, ureters, bladder, prostate, or urethra. The evaluation aims to determine where it is coming from and whether further testing is necessary.

Related Urologic Care

Because hematuria can originate from several parts of the urinary tract, the findings from your evaluation may lead to treatment for another urologic condition.

Kidney and ureteral stones can cause visible or microscopic blood in the urine, sometimes with significant flank pain and sometimes with few symptoms. When a stone is identified, Dr. Coutinho can determine whether observation, shockwave lithotripsy, ureteroscopy, or another approach is appropriate.

What Can Cause Blood in the Urine?

Hematuria is a finding rather than a diagnosis. Some causes are temporary or benign, while others require additional evaluation or treatment.

  • Urinary tract infection
  • Kidney or ureteral stones
  • Benign prostate enlargement (BPH)
  • Inflammation involving the urinary tract
  • Recent urinary procedures or instrumentation
  • Kidney disease
  • Trauma
  • Bladder, kidney, ureteral, or other urinary tract tumors
  • Certain medications or bleeding-related conditions
  • Urethral stricture or other abnormalities of the urinary tract

When Should Blood in the Urine Be Evaluated?

Visible blood in the urine generally warrants urologic evaluation, particularly when there is no clear temporary explanation. Microscopic hematuria is evaluated differently. Current American Urologic Association guidance uses a risk-stratified approach for workup of this finding.

For microscopic hematuria, Dr. Coutinho considers factors such as age, the amount of blood seen on microscopic urinalysis, smoking history, previous episodes of visible blood, and other risk factors for urinary tract cancer. Patients at lower risk may not require the same immediate evaluation as patients with intermediate or higher risk.

General Urology and Men’s Health-evaluation

Beginning Your Hematuria Evaluation

Evaluation begins with a consultation with Dr. Coutinho at East Coast Advanced Urology in Clifton, NJ. He will review whether the blood was visible or found on testing, whether it has occurred more than once, and whether you have pain, urinary symptoms, infection, kidney stones, or other relevant medical history.

Your evaluation may include:

  • Urinalysis with microscopic examination
  • Urine culture when infection is suspected
  • Review of kidney function and other laboratory testing when appropriate
  • Assessment of smoking history, medications, previous urinary conditions, and other risk factors
  • Imaging of the kidneys and urinary tract when indicated
  • Cystoscopy to directly examine the urethra and bladder when indicated
  • Additional testing based on the findings from the initial evaluation

Risk-Based Evaluation of Microscopic Hematuria

The American Urological Association guideline groups patients with microscopic hematuria according to their risk of urinary tract malignancy. This helps avoid unnecessary testing in very low-risk patients while ensuring that patients with greater risk receive an appropriate evaluation.

Depending on your risk category, the next step may range from repeat urinalysis to cystoscopy and imaging of the upper urinary tract. The type of imaging also depends on risk and individual medical factors. Dr. Coutinho will explain why a particular evaluation is or is not recommended rather than automatically ordering the same tests for every patient.

Cystoscopy for Blood in the Urine

Cystoscopy allows Dr. Coutinho to directly examine the urethra and inside of the bladder with a thin camera. It is an important part of the evaluation for many patients with hematuria because some bladder and urethral abnormalities may not be adequately assessed with imaging alone.

Imaging of the Kidneys and Urinary Tract

Imaging may be used to evaluate the kidneys and ureters for stones, masses, obstruction, or other abnormalities. The appropriate study depends on your risk level and medical history. Some patients may undergo renal and bladder ultrasound, while higher-risk patients may require more detailed imaging such as CT urography when medically appropriate.

Dr. Coutinho will select imaging based on the information needed while also considering kidney function, contrast allergies, radiation exposure, and previous imaging.

General Urology and Men’s Health-expect

Hematuria Follow-Up

Your Guide to Post-Hematuria Treatment Care

Follow-up depends on what is found during the evaluation. If a specific cause is identified, treatment and monitoring are directed toward that condition. If an appropriate risk-based evaluation is negative, additional follow-up is individualized based on your risk factors, whether blood continues to appear in the urine, and whether new urinary symptoms develop.

New visible blood in the urine, a significant increase in microscopic blood, or new urinary symptoms after a previous negative evaluation should prompt reassessment.

How Much Does a Hematuria Evaluation Cost in New Jersey?

The cost of evaluating blood in the urine in Clifton, NJ, and the greater New York metropolitan area depends on which tests are appropriate for your individual situation. Office evaluation, laboratory testing, cystoscopy, ultrasound, CT imaging, and other diagnostic procedures may each have separate costs and insurance requirements.

Insurance coverage varies by plan. The office can help you review your benefits and explain anticipated financial responsibility before scheduling additional testing or procedures.

Why Choose Dr. Coutinho?

Dr. Karl Coutinho is a fellowship-trained reconstructive urologist who evaluates hematuria in the context of the entire urinary tract. His practice includes cystoscopy, kidney stone treatment, bladder surgery, prostate evaluation, urethral reconstruction, and care for patients with previous pelvic surgery or radiation. This broad urologic and reconstructive background is useful when the source of bleeding is not immediately obvious or when more than one urinary condition is present.

Dr. Coutinho completed urology residency at Mount Sinai Hospital in New York City, followed by fellowship training in genitourinary trauma and reconstruction at Northwestern Memorial Hospital and University Hospitals of Cleveland. His academic work also includes a book chapter on complications of surgery in the previously irradiated field, an area in which urinary bleeding and complex tissue changes can require specialized evaluation.

His approach follows current American Urologic Association principles by matching the intensity of microscopic hematuria testing to the patient’s risk rather than assuming every patient needs identical testing.

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Patient Reviews

  • My surgery was life changing and the recovery period was better than I ever expected. I would highly recommend Dr Coutinho , he is the best.

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  • I had an outstanding experience with Dr. Coutinho and their entire urology team. They truly go above and beyond.

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  • Dr Karl Coutinho is an excellent doctor in his field. He made me feel whole again after doing two procedures for me.

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  • I’ve never met a doctor so empathetic

    I’ve never met a doctor so empathetic, professional and Knowledgeable Dr Coutinho performed a very difficult surgery on me. I had absolutely no pain.

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East Coast Advanced Urology

Schedule Your Consultation

If you have seen blood in your urine or have been told that microscopic blood was found on a urine test, schedule a consultation with Dr. Karl Coutinho at East Coast Advanced Urology in Clifton, NJ. He can review your symptoms, risk factors, and previous testing and determine what additional evaluation, if any, is appropriate. Dr. Coutinho welcomes patients from throughout the greater New York metropolitan area.

Contact East Coast Advanced Urology to schedule your consultation.

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