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Urology (Expert Forum)
Hematuria
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Hematuria
by Susan, Nov 18, 1999 12:00AM
I am a 39 year old female with a history of micro-hematuria in the urine. I have had frequent UTI's and over 15 urinalysis done in the past two years. I have also had right flank and back pain for the past 4 years. (which was diagnosed as gall bladder and was removed) I continue to have this pain. I also have lower abdomen pain which is constantly dull with occasionally sharp pain associated. I have had a normal IVP and a normal CAT scan showing no obstructions. I am now scheduled for a cystoscopy, a retrograde and some kind of test where the urologist will look in the ureters with a scope at the juntion sites where he has told me is a common area for stones. I assume he is also looking for bladder cancer. If you have bladder cancer would you have the flank and back pain? Also if you had bladder cancer with these type of symptoms for the past 4 years wouldn't you be very ill by this time and something would show up on a CAT scan? Can you have a kidney stone is the juntion area and it not show up on a IVP or CAT scan? Thank you for answering any of these questions!
Doctor's Answer
by hfhs M.D.-AK, Nov 22, 1999 12:00AM
Dear Susan,
Pain can occur in the kidney if the urine out-flow is inadequate. When and if you consume alcohol, a diuresis occurs and increases the urine output. If your output is increased substantially as it does when alcohol you consume alcohol in large quantities, you can have pains in the back, flank, or kidney due to the increased pressure in the system. The term for this condition is Dietl’s crisis.
Often this condition is associated with a borderline functional obstruction and during high rates of urine flow, the renal pelvis decompensates, resulting in severe abdominal pain and vomiting (similar to stone pain). When the pelvis drains sufficiently, the pain resolves. This is an intermittent condition and does not generally cause long-term damage to the renal parenchyma resulting in a loss of renal function.
Hematuria is the medical term for your condition. It is important to have a microscopic cell count done 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.
A full work -up consists of a history and physical to direct the studies ,an IVP which has already been done, 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, with 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. If you are febrile and have flank pain, you should be evaluated for a possible kidney infection. Also, blood in the urine could be caused by a simple infection of the bladder, which could be found on the Urine analysis(UA). If you have a documented bladder infection, you may just wait until it clears. If the UA is negative, the cystoscopy may not be necessary.
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. If the tumor is slow growing symptoms could be indolent (not obvious), but usually, there would be a hydronephrosis on the side 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.
I would suggest you have a repeat UA and if the microscopic analysis is high, RBC>3/HPF, see your urologist for a full evaluation which it sounds like has been scheduled.
In regaurds to the CT scan, a radiolucent stone on X-ray would be seen on CT and not on X-ray, so your negative CT may helpful later on to rule out stones, if nothing is found. Sometimes wide cuts on the CT scan can miss small stones. Ureteroscopy with a retrograde filling of the ureters with dye is another good option. The later is probably what your doctor recommended. I think this is fine.
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: Microhematuria
Pain can occur in the kidney if the urine out-flow is inadequate. When and if you consume alcohol, a diuresis occurs and increases the urine output. If your output is increased substantially as it does when alcohol you consume alcohol in large quantities, you can have pains in the back, flank, or kidney due to the increased pressure in the system. The term for this condition is Dietl’s crisis.
Often this condition is associated with a borderline functional obstruction and during high rates of urine flow, the renal pelvis decompensates, resulting in severe abdominal pain and vomiting (similar to stone pain). When the pelvis drains sufficiently, the pain resolves. This is an intermittent condition and does not generally cause long-term damage to the renal parenchyma resulting in a loss of renal function.
Hematuria is the medical term for your condition. It is important to have a microscopic cell count done 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.
A full work -up consists of a history and physical to direct the studies ,an IVP which has already been done, 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, with 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. If you are febrile and have flank pain, you should be evaluated for a possible kidney infection. Also, blood in the urine could be caused by a simple infection of the bladder, which could be found on the Urine analysis(UA). If you have a documented bladder infection, you may just wait until it clears. If the UA is negative, the cystoscopy may not be necessary.
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. If the tumor is slow growing symptoms could be indolent (not obvious), but usually, there would be a hydronephrosis on the side 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.
I would suggest you have a repeat UA and if the microscopic analysis is high, RBC>3/HPF, see your urologist for a full evaluation which it sounds like has been scheduled.
In regaurds to the CT scan, a radiolucent stone on X-ray would be seen on CT and not on X-ray, so your negative CT may helpful later on to rule out stones, if nothing is found. Sometimes wide cuts on the CT scan can miss small stones. Ureteroscopy with a retrograde filling of the ureters with dye is another good option. The later is probably what your doctor recommended. I think this is fine.
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: Microhematuria
