4-88
- Trace heme on a urine dipstick can be normal.
- Trace leukocyte urine can look significantly positive when viewed under the microscope.
- Cloudy urine in specimens with an alkaline pH (6 or higher) can be amorphous phosphate and be normal
in young individuals. - The presence of crystals in the urine does not automatically mean that the person has kidney stones.
Normal voiding
- Normal first urge to urinate occurs with about 5 ounces in the bladder.
- Normal bladder capacity in an adult is 10-15 ounces.
- Normal time between voiding averages greater than every 2 hours.
- Average total 24-hour urine volume for adults is about 1 quart. Ideal would be 2 quarts/day. This
translates to 40-80 ml of urine per hour.
Blood in the urine (hematuria)
- Trauma and visible blood in the urine suggests possibility of major injury. Stabilize and transfer for
evaluation. If patient is able to void, severe injury to bladder and urethra is much less likely. - Hematuria with irritative voiding symptoms should be treated initially as an infection. Exposure to bodies
of fresh water in Africa or the Middle East may lead to schistosomiasis as a cause of blood in the urine. - Hematuria with flank pain and:
a) No fever, no drug exposure and no trauma suggests a kidney stone.
b) Fever, but no trauma should be treated for a possible kidney infection.
c) High proteinuria, but no fever or drug or chemical exposure suggests nephritis. - Hematuria with painful scrotum should be treated initially as an infection.
- Gross hematuria (visible blood) without any other symptoms can be a sign of cancer at any age.
Blood in the semen (hematospermia)
If there are no difficulties voiding, the physical exam (including rectal exam) is normal and the urinalysis
several days after the event is negative, then this is a benign condition and no further workup is indicated.
Cannot control urine (leaking, incontinence) See Incontinence Section.
Cannot urinate (anuria)
Catheterization (see Procedure: Bladder Catheterization) is the best method of determining if there is an
obstruction versus poor urine production as an explanation for anuria. In a patient with a very large bladder by
palpation (dome of bladder extends more than half the distance between the umbilicus and the top of the pubic
bone), rapid drainage of the bladder can result in the patient fainting. For a more detailed discussion, see the
information on catheterization in the Prostatitis and Incontinence sections.
Discharge from the penis. Refer to section on STDs
Lumps in the genital region or swollen scrotum. Refer to section on Testis Mass and to STDs.
Pain in the side (ank). Refer to section on Urolithiasis
Pain in the scrotum
- Tenderness located primarily in the testis: consider torsion, epididymitis.
- Point tenderness on upper pole of testis: consider torsed appendix testis or cyst.
- Tenderness primarily in cord above testis: consider varicocele.
- Mass in testis: consider tumor.
- Mass above testis or around testis that glows when a strong light is placed against it: hydrocele or
spermatocele. - Large mass with history of direct blow to testis: fractured testis vs. hematoma.