Question Title: Visable blood in Urine

Was hospitalized w/ blocked left kidney at age 55 with perfect health about 6 months ago.... since then have passed stones and withstood the pain probably 7 or 8 times with good health for a couple of weeks at least in between these episodes. PROBLEM: Each time I play tennis (I play hard) there is now very visable blood in the first urination after playing... this returns to normal within the next few hours and later urination does not have visual blood.

This has been going on for over 7 weeks and when I didn't play the urine color was normal; but after resuming tennis last week I bled very visably in the urine each time. Several blood tests have been normal with the exception of Hematuria, and Bactrim was taken for a slight infection detected months ago.
At this writing I feel fine, but am very concerned and nobody seems to have answers other than expensive procedures which do not seem to produce factual results.

Dear William,
Hematuria is the term for your condition. It is important to have a microscopic cell count done on the urine test to determine if this amount of hematuria needs to have a full work-up. Above 3 RBC/HPF is suggestive of significant hematuria that needs work-up. However it sounds like you have gross hematuria occasionally(visible blood in the urine), this needs a full hematuria work-up regardless of whether it clears or not.
A full work -up consists of a history and physical to direct the studies ,an IVP, a cystoscopy which should be done by a urologist, and a cytology looking for cancerous cells in the urine. About 30% of patients at our institution have some pathology causing there hematuria.
Considering the symptoms that you describe, a urinary stone could be a possibility, however, if you have a negative IVP this would be less likely. Some stone are made of Uric acid and are not seen on IVP.
You could also have an infection, which you have been given antibiotics. This diagnosis could be made on the Urine analysis(UA).
A third possible diagnosis would be bladder cancer. Some times bladder cancer presents with blood in the urine and irritative symptoms. These patients usually do not have flank pain , but it is possible depending on the size and location of the tumor. This is why we perform cystoscopy, to rule out any suspicious lesions in the bladder. The cystoscopy also allows the urologist to examine the anatomy of the bladder and position of the ureteral openings in the bladder.
Our last diagnosis would be idiopathic, simply meaning, we don’t know. Patients that exercise or have bleeding disorders can often have blood in their urine without a good explanation. These patients get the same work-up listed above to ensure they don’t have a treatable condition.
With you history of gross hematuria, I think you need to be fully worked-up by a urologist. Hopefully they find everything is normal, but if there is something to treat, they can make some recommendations. In regards to the expense, I think you would want to know for sure if you had a problem. If you did have a cancer in your bladder, the urologist may be able to take care of it before it become invasive.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Hematuria

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