The presence of blood in urine, even at microscopic levels, could be a red flag for serious urological conditions in men. Urology(Urological) refers to kidneys, ureters, bladder and urethra. These are parts of the urinary system your doctor will begin to think about once you have blood in your urine as a man.
Blood in urine, whether a man or woman, is generally called Hematuria, which is a clinical term.
Hematuria in men is often a special case compared to women.
Hematuria, defined as the presence of ≥ 5 red blood cells per high-power field in a urine specimen, can originate from any part of the urinary tract(kidney, ureter, bladder, and/or urethra). When we examine urine samples under a microscope, we use two magnifications: low-power field(LPF) and high-power field(HPF).
LPF means looking under the microscope with a combination of an X10 objective lens and an X10 eyepiece lens, which gives a total of 100 times(100x) magnification.
HPF means looking under the microscope with a combination of an X40 objective lens and an X10 eyepiece lens, which gives a total of 400 times(400x) magnification.
So, if the HPF setting is used to view a man’s urine sample and up to 5 or more Red Blood Cells are seen, he is deemed to have blood in his urine or hematuria, and the cause MUST be evaluated.
Table of Contents
Why Would a Man Have Blood in His Urine?
There are many clinical scenarios of hematuria in men. It may signal a range of conditions, from benign issues to life-threatening diseases. Common causes include:
- Urinary tract infections
- Kidney stones
- Benign prostatic hyperplasia (BPH)
- Bladder or prostate cancer
- Kidney disease
As men age, the risk of certain conditions increases, making hematuria a particularly important symptom to investigate in older male patients.
How Does Urinary Tract Infections Cause Blood in Urine?
We know that one possible cause of blood in a man’s urine is Urinary Tract infection, but how exactly? Let me explain below.
Stage 1: Bacteria infection of any Urinary Tract(kidney, ureter, bladder and/or urethra). I mean bacteria gaining entrance to any of these parts.
Stage 2: Irritation and inflammation. The bacterial cells begin to cause irritation and inflammation of the affected parts, such as the bladder or kidney.
Stage 3: Damage to urinary tract mucosa. The irritation and inflammation are like scratching the inner lining(mucosa) of a bladder, ureter, etc.
Stage 4: Red Blood Cell Leakage. As irritation and inflammation damage the mucosa of any urinary tract, red blood cells leak out of the tiny blood vessels(capillaries) into urine.
When the man urinates, the blood passes with the urine, and if there is a lot of blood in the urine, it will be visible. This is termed gross hematuria.
To avoid making this article lengthy, you can read below how the other conditions cause blood in urine.
How Kidney stones cause blood in urine
How Benign prostatic hyperplasia (BPH) causes urine in blood
How Bladder or prostate cancer cause blood in urine
How Kidney disease causes blood in urine
How Blood in Urine is Diagnosed in a Medical Lab
When confronted with hematuria in male patients, a systematic diagnostic approach is used:
In medical laboratories, urine samples are usually examined with the naked eye by medical lab scientists. If the hematuria is gross, we can identify a urine sample with blood. We also perform urinalysis using strips and microscopy.
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Urinalysis with the strip
The strip is quick and easy to perform. It indicates whether blood is present in a urine sample, and this test can even be done at home.
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Urine microscopy
This is the gold standard for hematuria diagnosis. It not only confirms the presence of red blood cells but can also provide clues about their origin(kidney, ureter, bladder and or urethra)
During microscopy, the morphology of the red blood cells is checked, and they can indicate the source of bleeding. Dysmorphic (misshapen or distorted) red blood cells often suggest a glomerular(kidney) origin, while intact RBCs point to a lower urinary tract (bladder and urethra) source.
Conclusion
What would cause blood in urine for a man is looked differently from that of a woman and is approached with a high index of suspicion. While it’s easy to attribute such symptoms to benign causes, especially in younger patients, the potential for serious underlying conditions necessitates thorough investigation.
Phase contrast microscopy can enhance our ability to differentiate between glomerular and non-glomerular hematuria, providing valuable diagnostic information.
