Urology/urine

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QUESTION: sir i am a 15 year old boy no histroy of urinary problem
one saturday in night i noticed few drops of pink colour urine
next day morning my urine urine become bright red urine with no pain
next urine was also that colour after i drink lots of water the urine started becoming lighter in colour on monday it become normal in colour i went to doctor have a blood test urine microscopic test which show rbc was nil and a ultrasound which was normal the blood test was also normal few days i take one more urine microscopic test which show rbc was nil sir search in net which show that painless bright red is symptom of bladder cancer i am afraid

ANSWER: Pankaj, Although red discoloration of the urine is usually due to blood, it may also occur from the excretion of some pigments in the foods we eat.  The most common are from beets, rhubarb, & blackberries.  Certain medications & chronic toxicity from lead or mercury may produce red urine as well.

There are many possible causes for blood in the urine (hematuria).  The origin of the bleeding can come from the upper (kidneys or ureters) or lower (bladder, prostate, urethra) urinary tract.  Blood seen only under the microscope (microscopic hematuria) is usually of a benign nature whereas gross hematuria is potentially more serious. With gross hematuria, it is important to note the relationship of the bleeding to the urinary stream.  If at the beginning of urination (initial hematuria), the source of the blood is almost always in the urinary canal (urethra).  If at the end of urination (terminal hematuria), the source is usually the prostate gland in men or the bladder neck in men and women.  Bleeding throughout the entire stream (total hematuria) is due to bleeding that is initiated in the urinary bladder or upper urinary tract (kidneys and/or ureters).  

Some of the common causes of hematuria include infection, tumors, stones, and trauma (injury).  Tumors of the bladder or kidneys can occur but are quite uncommon at your age.  In order to look for the cause, it is necessary to consult a urologist.    A history, physical examination, urine cytology, and other laboratory tests are done.  In recent years, the FISH assay of the urine has been used in lieu of or in place of the urinary cytology.  This test has proven to be much more sensitive and specific in detecting bladder cancer in voided urine specimens or bladder washings. Visualization of the kidneys by imaging studies (ie IVP, ultrasound, CT or MRI) and examination of the lower urinary tract with a cystoscope are usually required.  I suspect that the ultrasound you had was of the kidneys and this is reassuring that it was normal.  Although an ultrasound of the bladder can also be done, a cystoscopic examination is preferred if the presence of blood is documented.

I suggest that if see red urine again, that it be saved and taken to the urologist to determine if it is truly blood or pigments.  Also record any food or medications you had taken that day.  As mentioned above, also note the discoloration of the urine in relation to the urinary stream - beginning, end or all the way through.   
In summary, consultation with a urologist is needed to determine the cause and seriousness of the hematuria.  Again, at your age, in most cases the etiology is not serious.  Good luck!

---------- FOLLOW-UP ----------

QUESTION: sir my ultrasound of bladder was also normal the urine discoloration occur about 2 month ago
after seeing the urine i went to the doctor i have a urine test which show rbc was nil
sir a day before i saw bright red urine i eat two pink cotton candy in night
could this could cause bright red discoloration of urine

Answer
Pankaj, pink cotton candy has been reported to discolor the urine more of a pink color than red.  Generally, this occurs if one consumes large amounts of the candy and takes minimal liquids so that they are relatively dehydrated.  This concentrates the urine and make the discoloration more obvious.  I am glad that both your bladder and kidney ultrasounds were normal.  Still, the safest strategy is to see a urologist.  Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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