Blood in the urine, known medically as haematuria, can be alarming, whether or not it appears with pain, urinary symptoms, or feeling unwell. Kidney, ureteric and bladder stones can also trigger sudden, severe pain, often alongside blood in the urine, nausea, infection, or difficulty passing urine, particularly when a stone blocks the flow of urine from the kidney to the bladder.

Although these symptoms are commonly linked to non-cancerous conditions such as infection, an enlarged prostate, or urinary stones, they should never be ignored – even if they come and go. In some cases, they may signal an underlying condition that requires a prompt assessment by a Urologist.

In this article, Mr Stefanos Almpanis, Consultant Urologist at New Victoria Hospital, explains what haematuria and urinary stones are, what causes them, and the symptoms to look out for. Drawing on experience from more than 7,000 procedures for haematuria and urinary stone disease, he also outlines how specialist assessment can help reach an accurate diagnosis and guide treatment.

What is haematuria?

Haematuria means blood in the urine. Sometimes it may be visible – when urine appears pink, red, brown or tea-coloured – or non-visible, where blood is only detected on testing. A urine dipstick test is a simple and easy way to check for blood and infection. While a trace amount of blood may not be significant or a cause for worry, persistent or higher levels should always be investigated, as soon as possible.

Common reasons for blood in the urine

Blood can come from anywhere in the urinary tract, including the kidneys, ureters, bladder, prostate, or urethra. Common causes include urinary tract infections, kidney or bladder stones, an enlarged prostate, as well as inflammation. Less commonly, it may be linked to cancers of the bladder, kidney or prostate.

The British Association of Urological Surgeons advises that confirmed blood in the urine, whether visible or non-visible, should always be investigated. It also notes that infection is the most common cause of haematuria in the UK, but that further assessment is needed when infection is not the explanation. 

Why men should not ignore blood in the urine

While it does not always mean something serious, haematuria can occasionally be an early warning sign of urological cancers, such as prostate, bladder or kidney cancer. A prompt assessment is therefore important, particularly if you are over 45, smoke or have smoked in the past, have recurrent urinary symptoms, notice signs of bleeding without a clear infection, or have a family history of urological cancer.

You should seek medical advice if you notice:

• Blood in your urine, even if it happens only once
• Pain in the back, side, lower abdomen or groin
• Burning, stinging or difficulty passing urine
• Needing to pass urine more often or urgently
• Fever, shivering or feeling generally unwell
• Inability to pass urine
• Recurrent urinary infections
• Unexplained weight loss, tiredness or persistent pain

A Consultant Urologist can help identify whether the cause is related to infection, stones, prostate, kidney, or something requiring further investigation.

“Blood in the urine should always be taken seriously, even if it happens only once or settles on its own. In many cases, the cause is benign, but proper assessment allows us to identify the problem early, treat symptoms effectively and reassure patients when no serious cause is found.” Mr Stefanos Almpanis, PhD, FEBU, FHUA, Consultant Urologist

What are urinary stones?

Urinary tract stones are hard deposits that form from minerals and salts in the urine. Renal stones form in the kidneys, a condition known as nephrolithiasis. When these stones move out of the kidney into the wider urinary tract – such as the ureters, bladder, or urethra – it is referred to as urolithiasis.

Most are small enough to pass naturally, but some can get lodged in the kidney or ureter – the tube that drains urine from the kidney to the bladder. While others can grow large enough to require surgical treatment.

Interestingly, an Ig Nobel Prize-awarded study found that riding a moderate-intensity roller coaster may help some small kidney stones (5 mm or less) to dislodge and pass naturally. However, the findings came from a model-based experiment and have been debated, so roller coasters should not be considered a substitute for medical advice or treatment.

When a stone blocks the ureter, it can cause renal colic – sudden, severe, often excruciating pain that may come in waves and move from the back or side towards the groin and the testicle. Stones can also cause blood in the urine, nausea, vomiting, urinary symptoms and infection.

Digging deeper for the real cause of kidney stones

For many patients, treating the stone is only part of the story. Understanding why the stone formed in the first place is just as important, especially in patients who have had more than one stone, have stones at a young age, have multiple or bilateral stones, have a family history of stone disease or medical conditions that increase stone risk.

Emerging research is also adding a new layer to our understanding of stone formation. One study found bacteria inside calcium oxalate stones, suggesting that the most common type of kidney stone may be more complex than previously thought and not driven by chemical and physical processes alone. However, much more research is needed before any medical recommendations or treatments can be based on these findings.

Kidney stones and metabolic syndrome

Kidney or renal stones are not always an isolated issue. In some cases, they may be linked to wider health factors such as the metabolic syndrome. This is an increasingly common cluster of conditions that often occur together, such as:

• carrying excess weight around the waist,
• high blood pressure,
• abnormal cholesterol or triglyceride levels, and
• problems with blood sugar control, including insulin resistance or type 2 diabetes.

These factors can affect the chemistry of the urine and increase the risk of stone formation. In particular, people with obesity, insulin resistance, or type 2 diabetes may be more likely to develop uric acid stones, which can form when the urine is too acidic.

This is one reason why metabolic testing can be valuable. It can help identify whether a patient’s stones are linked to dehydration, diet, high salt intake, abnormal calcium handling, low urinary citrate, high uric acid levels, acidic urine, insulin resistance or diabetes.

By identifying these risk factors, we can provide a tailored prevention plan. For some patients, this may include personalised guidance on fluid intake, diet, salt intake, calcium balance, weight management, or treatment of an underlying metabolic condition and risk factors, or using medication such as urinary alkalinisation in selected patients with uric acid stones.

Specialist treatments and investigations for haematuria and urological stones at New Victoria Hospital

At New Victoria Hospital, Consultant Urologists provide specialist assessment and treatment for men with:

• blood in the urine,
• kidney stones,
• ureteric stones and
• related urinary symptoms.

Our Consultants can investigate haematuria and manage urinary stone disease using modern diagnostic imaging. These investigations will also help your Urologist to advise whether a stone is likely to pass naturally, or whether treatments such as shockwave lithotripsy, ureteroscopy with laser stone fragmentation, or PCNL may be more appropriate.

In addition to managing the immediate stone problem, our Consultants can arrange and interpret further specialist testing, especially for recurrent or higher-risk stone formers, to look for underlying causes:

• Metabolic testing may include blood tests, urine tests and, in selected patients, 24-hour urine collection. This can measure factors such as urine volume, acidity, calcium, oxalate, citrate, uric acid, sodium and other markers that influence stone formation.
• If a stone has been passed or removed, it can also be sent for stone analysis. As the guidance from the European Association of Urology notes, once the mineral composition of a stone is known, a potential metabolic disorder can be identified. Understanding the cause of stone formation also allows Consultants to provide more personalised prevention advice.

“Treating the stone is only part of the picture. As no patient is the same, I focus on the individual and practice holistic assessment and treatment, aiming to provide a clear diagnosis, explain treatment choices in plain language, and tailor care to each patient’s symptoms, lifestyle and priorities.

For many patients, especially those with recurrent stones or risk factors such as metabolic syndrome, diabetes or obesity, metabolic testing helps us understand why stones are forming and how to reduce the chance of future episodes.” Mr S. Almpanis, PhD, FEBU, FHUA, Consultant Urological Surgeon

Your treatment will depend on the size, position, and type of stone, as well as your symptoms, kidney function, and whether infection is present.

• Smaller stones may be managed with pain relief, hydration and careful monitoring.
• Larger stones, infected stones, or stones causing obstruction may require active treatment.

The main surgical treatments for larger kidney stones include:

• Shockwave Lithotripsy, also called a surgery without a knife as it uses targeted shockwaves to break moderate size kidney stones into smaller fragments that can pass naturally.
• Holmium Laser Lithotripsy via flexible ureteroscopy, which uses laser technology to break the stones into fine fragments or powder.
• Percutaneous Nephrolithotomy, often called PCNL, a keyhole surgery that is used to remove larger or more complex and stubborn kidney stones.

The choice of procedure will be determined by the size and location of your stone.

Key take-home messages

• Blood in the urine is common but should always be checked, even if there is no pain.
• Kidney stones can cause severe pain, blood in the urine, infection or blockage of the kidney.
• Most causes of haematuria are not cancer, but specialist assessment is important to rule out serious conditions.
• Modern stone treatments are often minimally invasive and can be tailored to the size and position of the stone.
• Metabolic testing and stone analysis can help identify why stones form and guide personalised prevention advice.

If you are concerned about your symptoms or would like specialist advice, please book an appointment with our Urology Consultants:

call 020 8949 9020 or fill out our online enquiry form.