Hematuria

A 68-year-old White man is concerned because he thinks he is peeing blood. He noticed it about 1 month ago, and he thought it was related to sex as he noticed it right after intercourse. However, he has had two other episodes within the past two weeks not related to sexual intercourse. He denies fever, dysuria, frequency, abdominal, back, or pelvic pain. He states he used to have a weak stream and have to urinate at night, but these symptoms have improved since starting finasteride (5α-reductase inhibitor). 

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  • Past medical history: BPH.
  • Medications: finasteride.
  • Allergies: no known drug allergy (NKDA).
  • Social history: has smoked 1 pack of cigarettes per day for the past 40 years; drinks two to three beers on the weekends.
  • Physical examination: body mass index 32; vital signs and examination are within normal limits.
  • Urinalysis with microscopic evaluation: positive for blood with 40 RBCs/HPF; no casts or dysmorphic cells noted.

1. Discuss most likely cause of the hematuria. Discuss data that supports your decision as well as diagnostic and treatment strategies.