Blood in urine is not a disease in itself but a symptom of other problem. The cure is based on the cause, the severity and the overall health of the patient.
Here’s an overview:
Common Causes of Hematuria
Urinary tract infection (UTI)
Infection of the kidney (pyelonephritis)
Kidney or bladder stones
Enlarged prostate (in men)
Gangular 0uphritis (inflammation of kidney filters)
Kidney disease or injury
Bladder or kidney cancer
Strenuous exercise
Some of the drugs (blood thinners, analgesics)
Treatment (Causal)
Urinary Tract Infection
Antibiotics (on the prescription of the urine culture).
Increase water intake.
Kidney or Bladder Stones
Pain relievers.
Drugs that are used to clear tiny stones.
That would be shockwave lithotripsy, ureteroscopy or surgical treatment of larger stones.
Enlarged Prostate (BPH)
Alpha-blockers or 5-alpha-reductase.
Least amount of surgery or surgery when severe.
Glomerulonephritis / Renal Disease
Blood pressure (ACE inhibitors, ARBs).
Corticosteroids or immunosuppressants (in case related to immune).
Dialysis (in severe cases).
Bladder or Kidney Cancer
Depending on the stage, surgery, chemotherapy, radiation or immunotherapy.
Exercise-Induced Hematuria
Usually self-limiting.
The patient should not exercise usually until the clearance.
Supportive Care
Adequately hydrate by drinking a lot of fluids to clear the urinary tract.
Keep off irritants such as caffeine, alcohol and smoking.
Watch the color and frequency of urine.
Hematuria diagnosis and treatment
Diagnosis of Hematuria
As hematuria may occur at any point in the urinary tract (kidneys, ureters, bladder, prostate, urethra), physicians tend to proceed in the following order:
Medical History/Physical Exam
Inquiries to make: pain, frequency, fever, recent exercise, trauma.
Test kidney stones history, infections, smoking, medications (blood thinners).
Urine Tests
Urinalysis: red blood cells, protein, infection, crystals checks.
Urine culture: identifies bacteria as causes of UTI.
Urine cytology: examines the presence of cancer in urine.
Blood Tests
Kidney (creatinine, BUN) function.
Clotting profile when there is a possibility of bleeding disorder.
Imaging Tests
Ultrasound: prostate, kidneys, bladder.
CT Urogram: detailed scan to find stones, tumors or structural problems.
MRI (occasionally of soft tissue).
Cystoscopy
Thin scope inserted into bladder to examine presence of tumors, stones or structural anomalies.
Hematuria (Cause-Based) Treatment
UTI: Antibiotics (e.g. nitrofurantoin, fosfomycin, ciprofloxacin -based on culture), hydration.
Kidney / Bladder Stones: painkillers, fluids, ureter relaxation, lithotripsy (shock wave), ureteroscopy, or surgery to remove large stones.
BPH (Big Prostate): Alpha-blocker (tamsulosin), 5-alpha-reductase inhibitor (finasteride), TURP (surgery) in severe cases.
Glomerulonephritis / Kidney Disease: ACE inhibitors / ARBs to regulate blood pressure, steroids (immunosuppressants), dialysis (severe) when crippling.
Bladder or Kidney Cancer Surgery: (TURBT, nephectomy), chemotherapy, radiation, immunotherapy depending on stage.
Exercise-Induced Hematuria: This is usually self-limiting and heals with rest, ongoing hydration, and no overextention.
UT Trauma: Consideration (in mild case), purulent drainage, surgery in case of severe injury.
Medication-Induced (blood thinners, NSAIDs): Change/Discontinue a drug when advised by a doctor.
Best hematuria treatment in India
Diagnosis & Treatment Protocols in India
India adheres to evidence-based, internationally-normed practice of hematuria, specific to the cause:
Chief Complaint (usually by general practitioners or local physicians):
Do urinalysis, urine culture, and ultrasound.
Simple UTIs are able to be managed on the first line.
The cases that may indicate glomerular disease (e.g., fevers, swelling of the face, dysmorphic RBCs, high blood pressure) are to be referred to a nephrologist.
Results suggesting the presence of malignancy or stones should be urology-referred to advanced treatment.
Specialty Medical Dialogues
Cause-Based Management:
UTIs → Antibiotic and hydration therapy.
Stones → It can be hydrated, medicated, lithotripsy, or removed in surgery.
BPH → Medical treatment, or operation (i.e. TURP or open-surgery) in case of complications such as recurrent UTIs or gross hematuria occur.
Kidney disease (e.g. glomerulonephritis) → Treated by nephrologists, may need immunosuppressants or dialysis.
Cancer (bladder/kidney) - Referral to oncology or urology to stage and treat it, including surgery, chemo or radiation.
Follow-up:
In case of the inconclusive results of the initial work up, further microscopy and blood pressure checks every 3-6 months are suggested, particularly where there are risk factors, such as smoking or exposure to chemicals.
Hematuria causes and treatment
Hematuria may be microscopic (blood may only be seen under a microscope) or gross (blood may be visible in urine).
Common Causes of Hematuria:
Infections
UTI (Urinary Tract Infection) - bacteria can cause bleeding and inflammation.
Kidney infection (pyelonephritis) - typically with fever, chills, and flank pain.
Stones
Bladder or kidney stones - sharp edges scratch the lining and are bleeding.
Prostate Disorders (in men)
Benign Prostate Hyperplasia (BPH) - swollen prostate can be bleeding.
Prostatitis -inflammation/infection.
Kidney Conditions
Glomerulonephritis -inflation of kidney filters.
Polycystic kidney disease.
Trauma of kidneys (trauma, accidents).
Cancers
Bladder cancer, renal cancer or prostate cancer.
Frequently with painless visible blood in the urine.
Cancers : Surgery, chemotherapy, radiation or immunotherapy by type and stage.
Medication induced: Dose change or the change of medicines under medical advice.
Exercise induced: Rest, hydration, self-limiting to treatment in most cases.
Trauma: Noticing whether mild or surgery-threatening.
Advanced hematuria treatment options
Complex treatment of hematuria - these are usually utilized when first-line therapy (such as antibiotics against UTI or plain medications against stones/prostate) is not sufficient, or when the etiology is more complicated (such as cancers, resistant stones or advanced kidney disease).
State of the art Hematuria treatment:
For Kidney or Bladder Stones
Shock Wave Lithotripsy (SWL) – is not invasive, destroys stones into tiny pieces through sound waves.
Ureteroscopy and Laser Lithotripsy- a small scope is inserted into the ureter/kidney and a laser is utilized to fracture stones.
Percutaneous Nephrolithotomy (PCNL) - keyhole surgery of large/complex stones minimally invasive.
Mini-PCNL & Micro-PCNL- newer versions, with less bleeding, quicker recovery.
For Enlarged Prostate (BPH)
Transurethral Resection of Prostate (TURP) - gold standard operation in the removal of overgrowth of prostate tissue.
Laser Enucleation (HoLEP, ThuLEP) - less invasive laser treatment that is less likely to result in bleeding.
Urolift & Rezum Therapy- more recent procedures of small scale to open urinary passage without a big operation.
For Bladder or Kidney Cancer
Transurethral Resection of Bladder Tumor (TURBT) - Tumors of the bladder which are removed endoscopically.
Intravesical Therapy - The induction of BCG immunotherapy or chemotherapy into bladder.
Robotic/Laparoscopic Surgery -nephectomy (kidney removal) or cystectomy (bladder removal) using smaller incisions, quicker recovery.
Targeted Therapy & Immunotherapy - checkpoint inhibitors are advanced drugs used in the treatment of advanced cancers.
Immunosuppressive Therapies- advanced autoimmune based kidney inflammation biologics or targeted drugs.
Plasmapheresis-purges bad antibodies in blood in some kidney diseases caused by the immune system.
Dialysis & kidney transplant- in end stage kidney disease with recurrent hematuria.
For Vascular Causes
Endovascular Embolization- an extremely less invasive operation where interventional radiologists block unnatural blood vessels that trigger blood loss in the kidney or bladder.
Angioplasty & Stenting- in case hematuria is attributed to the narrowing or malformation of the renal artery.
Unexplained / Refractory Hematuria
Cystoscopy with Fulguration - laser/ burning of bleeding bladder vessels.
Intravesical Alum or Formalin Therapy - persistent bleeding of the bladder (last-resort hospital-based therapies).
Hyperbaric Oxygen Therapy (HBOT) - in cases of radiation induced hematuria (following cancer therapies).
Advanced, Supportive Diagnostics
Flexible cystoscopy- real time image to locate the source of bleeding.
CT Urogram & MRI Urogram - detailed images to identify any tumors, stones or vascular malformation which are not evident.
Hematuria specialist doctors in India
Dr. Rajiv Yadav
Dr. Gagan Gautam
Dr. Anil Mandhani
Dr. Rajesh Ahlawat
Dr. Anupam Bhargava
Hematuria surgery in India
For Kidney or Bladder Stones
Ureteroscopy Lithotripsy (Laser)
Endoscopic surgery: a scope that is inserted into the ureter/kidney; laser cuts stones.
Percutaneous Nephrolithotomy (PCNL)
The use of keyhole surgery on large/complex kidney stones.
Mini / Micro PCNL
Less invasive and use of small instruments, faster healing.
Shock Wave Lithotripsy (SWL) (non-surgical yet is characterized as a procedure)
It is the sound waves of the outside that cut stones.
Enlarged Prostate (BPH) in Men
Transurethral Resection of the Prostate (TURP)
The gold standard surgery, which is done through the urethra, removes prostate tissue.
Laser Enucleation (HoLEP / ThuLEP)
Less-blood procedures with advanced laser.
Open / Robotic Simple Prostatectomy
In very large prostates in which TURP is inadequate.
Bladder Tumors / Bladder Cancer
Transurethral Resection of Bladder Tumor (TURBT)
Bladder tumor causes bleeding which has been removed endoscopically.
Radical orpartial Cystectomy
Part or total removal of the bladder by surgery (robotic/laparoscopic possible).
Intravesical Therapy (post-surgery)
Chemo/BCG into bladder as prophylaxis.
Kidney Tumors / Kidney Cancer
Partial Nephrectomy
Cures tumor, spares kidneys.
Radical Nephrectomy
Removes the whole kidney (open, laparoscopic or robotic).
Severe or Persistent Bladder Bleeding
Cystoscopic Fulguration
Laser/ endoscopic treatment of bleeding bladder vessels.
Blocks kidney or bladder abnormal blood vessels which lead to bleeding.
Stenting / Renal Artery Surgery
In case bleeding is as a result of artery abnormality.
Hematuria treatment in India with GetWellGo
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