Re: What are the possibilities?

Posted By Janice D. on April 15, 1999 at 15:43:57
A few months ago I was diagnosed with fibromyalgia.  My ANA tests came back positive, but my doctor thought I didn't have lupus. Now, I went to the doctor because I thought I had a bladder infection.  Urinalysis test said no infection but there was blood in my urine.  My symptons include pressure in the lower abdomen, frequency (approx. every 20 minutes), fatigue, overall aches etc...My doctor is sending me for a kidney ultrasound and IVP Tuesday.  What are the possibilities that they are looking for???

[hfhs M.D.-AK]

Posted By HFHS M.D.-AK on April 16, 1999 at 15:08:21
Dear Janice,
Hematuria is the medical term for your condition.  It is important to have a microscopic cell count done on your urinalysis 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 scheduled, 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.  An ultrtasound is just another method to examine the kidneys, and the IVP should cover this area.  Maybe you meant a cystoscopy?
Considering the symptoms that you have, a urinary stone, urinary tract infection, or interstitial cystitis could all be a possibilities. A fourth 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 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 dont know.  Patients that exercise, have kidney disease(Lupus) 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 dont have a treatable condition.
I think your doctors are treating you correctly.  The last think you want to miss is a superficial bladder cancer or some anatomic abnormality that can be treated before a big problem occurs.  Chances are, the tests will be negative, but then you can rest easier knowing your bladder , ureter, and kidneys are all fine.
To find out more about interstitial cystitis, pleases look at other questions on this site.  I think you will find what you are looking for.
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

[Janice-D]

Posted By Janice D. on April 22, 1999 at 09:00:40
I had a renal ultrasound and IVP done Tuesday.  They said I have a kidney stone in the lower right kidney and a possible peri-pelvic cyst on my left side (what is this?????) I have an appointment with a urologist named Dr. Weyrich - do you know anything about him??? What can I expect from this appointment??? I know that the stone probably is the cause of blood in urine, but will this also cause frequent urination and pressure in bladder???? I would very much appreciate your response.  Thank you.

[Janice-D]

Posted By Janice D on April 22, 1999 at 12:25:58
Also, can a cyst ever be cancerous?? When they say possible cyst, what else could it be?  Is the discomfort in my back and lower abdomen possibly caused from the stone or is it a "side effect" from my fibromyalgia?

[HFHS M.D.-AT]

Posted By HFHS M.D.-AT on April 27, 1999 at 09:09:56
Dear Janice:
Thanks for your question. It seems that during investigations for blood in urine, an intravenous pyelogram was performed on you, which picked up a ureteric stone on left side and a parapelvic cyst on the right side. The summary of your questions is as follows: a), what is a parapelvic cyst and can it be cancerous? b) You want to know about your urologist and if c) bladder pressure and frequency of urination can be due to stones and finally d) you also want to know if back pain you have is due to stones or fibromyalgia (which you have for some time).
Please allow me to answer point by point.
a) The parapelvic cyst usually is a non cancerous fluid filled sack which is present around the upper part of ureter. This is usually of no consequence
b) I personally dont know your urologist. He should be good if he is qualified. Look for certification by the American Board of Urology.
c) Yes- bladder pressure and increased frequency of urination could be due to the lower ureteric stones.
d) Back pain could either be due to stones or fibromyelgia.  However if pain persists after treatment of your stones, it is likely due to fibromyalgia.
Hope this information will be of some help to you.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. The Henry Ford Hospital Department of Urology has experience in the evaluation and treatments of problems such as you describe. We would be most interested in helping you. You can reach us through our toll-free number 1-800-653-6568.
We can also arrange local accommodations through this number if this is your need. Please bring any x-rays (not just the reports) as well as any physicians' notes and lab test results that you may be able to obtain. These will help us greatly.
Sincerely,
HFHS M.D.-A.T.
*Key word: stones, hematuria











Follow Ups: