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Urology (Expert Forum)
hematuria --spina bifida
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 --spina bifida
by Rosemary Rybicki, Sep 13, 1999 12:00AM
My question has to do with hematuria that my son has been experiencing. He has recurrent occurences. The last time he experienced it he had an ivp which indicated a slight spina bifida. Although he is 22 years old this is the first we have been aware of this congenital problem. He experienced some hematuria at the onset of puberty but the doctor we had at that time did not seem to be concerned with it. The only problem he seems to have with this is the hematuria and bladder spasms with frequency. He has no health insurance so he is reluctant to have further testing. Do you feel a cystoscopy would be helpful? My
main concern is that we may be overlooking some kidney problem.
Is there any medication that would help him? I have encouraged him to force fluids and empty his bladder fequently but the last doctor he had said he wasn't emptying his bladder. Should he be evaluated for residual urine. ?
main concern is that we may be overlooking some kidney problem.
Is there any medication that would help him? I have encouraged him to force fluids and empty his bladder fequently but the last doctor he had said he wasn't emptying his bladder. Should he be evaluated for residual urine. ?
Doctor's Answer
by HFHS M.D.-BE, Sep 17, 1999 12:00AM
=============================================
Dear Rosemary,
The presence of blood in urine (hematuria) is cause for concern and must be evaluated by a physician to discover its source. Blood could be visible to the eye as in your son's case, or microscopic( visible with the aid of a microscope). There are multiple reasons why someone might have hematuria, and each person's medical history is an important part of the differential diagnosis process. Some of the causes are kidney stones; inflammation or infection; trauma; tumors; bleeding from prostate veins; blood clotting problems; and abnormal blood vessels. Certain medications could cause irritation, as well, which would produce hematuria. Some treatments, such as radiation or chemotherapy, could also cause it. Bladder cancer affects men three times more frequently than women, white men more frequently than black men, and smokers two to five times more frequently than nonsmokers. In addition, there are certain environmental/occupational hazards which contribute to bladder cancer. Workers in dry cleaning plants, rubber factories, and people who work around dyes, have a higher incidence of bladder cancer than the general population. Sometimes, heavy physical jobs could cause bleeding from the veins in the prostate gland, which is another possible cause for your son's bloody urine. This, however, is more common in the elderly.
Your son may be having what is referred to as spina bifida occulta, which means : hidden spina bifida. This is usually not significant clinically, but some individuals may have some residual deficits, such as inability to urinate properly and to completely empty their bladder. This potentially predisposes them to urinary/bladder infection and even kidney failure.
In the case of your son, given the history you have outlined, he may be suffering from a urinary tract infection, due to his inability to completely empty his bladder, leading to hematuria. Regardless, he must see a urologist for an evaluation, since the earlier the problem is found, the easier it is treated without too many complications.
It is unfortunate that he does not have any insurance, but he should be seen by a urologist. The appropriate workup for someone with hematuria includes: IVP (an X-ray examination), urine culture and urine cytology (looking at the cells in the urine), cystoscopy (looking inside the bladder with a scope), and possibly, bladder biopsy. Once a diagnosis is made, the urologist will make the appropriate treatment recommendations. Bladder function is also affected in spina bifida, and a post void residual urine volume shouold be checked. Urodynamic studies regarding blsadder pressures is also suggested.
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.-BE
*Keyword: hematuria
Dear Rosemary,
The presence of blood in urine (hematuria) is cause for concern and must be evaluated by a physician to discover its source. Blood could be visible to the eye as in your son's case, or microscopic( visible with the aid of a microscope). There are multiple reasons why someone might have hematuria, and each person's medical history is an important part of the differential diagnosis process. Some of the causes are kidney stones; inflammation or infection; trauma; tumors; bleeding from prostate veins; blood clotting problems; and abnormal blood vessels. Certain medications could cause irritation, as well, which would produce hematuria. Some treatments, such as radiation or chemotherapy, could also cause it. Bladder cancer affects men three times more frequently than women, white men more frequently than black men, and smokers two to five times more frequently than nonsmokers. In addition, there are certain environmental/occupational hazards which contribute to bladder cancer. Workers in dry cleaning plants, rubber factories, and people who work around dyes, have a higher incidence of bladder cancer than the general population. Sometimes, heavy physical jobs could cause bleeding from the veins in the prostate gland, which is another possible cause for your son's bloody urine. This, however, is more common in the elderly.
Your son may be having what is referred to as spina bifida occulta, which means : hidden spina bifida. This is usually not significant clinically, but some individuals may have some residual deficits, such as inability to urinate properly and to completely empty their bladder. This potentially predisposes them to urinary/bladder infection and even kidney failure.
In the case of your son, given the history you have outlined, he may be suffering from a urinary tract infection, due to his inability to completely empty his bladder, leading to hematuria. Regardless, he must see a urologist for an evaluation, since the earlier the problem is found, the easier it is treated without too many complications.
It is unfortunate that he does not have any insurance, but he should be seen by a urologist. The appropriate workup for someone with hematuria includes: IVP (an X-ray examination), urine culture and urine cytology (looking at the cells in the urine), cystoscopy (looking inside the bladder with a scope), and possibly, bladder biopsy. Once a diagnosis is made, the urologist will make the appropriate treatment recommendations. Bladder function is also affected in spina bifida, and a post void residual urine volume shouold be checked. Urodynamic studies regarding blsadder pressures is also suggested.
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.-BE
*Keyword: hematuria
