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Urology  (Expert Forum)
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Repeated Episodes Several Years of Blood in Urine
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
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.

Repeated Episodes Several Years of Blood in Urine

by lambudd, May 16, 2003 12:00AM
61 year old female -

For several years, since age 45, I have been getting Kidney stones with treatment using lithotripsy and surgical removal -- they repeatly come back.   Need to know causes and types of stones (am never told by my Urologist when I request the composition of the stone) -- after the stones are removed, I still get bloody urine and I fear the correct diagnosis hasn't been made. Sometimes I am sick, listless, and slow moving. Spasms also occur at night running down both thighs from the groin.  Confused if it is also combined bladder and kidney problems? I am also Diabetic Type II, taking several medications. (Glucophage, Actos, Accupril, and Synthroid) How do I pinpoint the cause? Diet, Medication, Environmental, Drinking Water, etc?



Blood deposits range from dark cloudy tea to bright red episodes. Had an IVP several months ago, and the dye did not go all the way down through the left tube.  The technician said it should be questioned.  When I questioned my Urologist, he say not to worry and dismissed it.  Yet, blood still passes in different colors/quantities and the treatment is with CIPRO.  It stops for a while and comes back.  I drink tons of water to flush -- then blood subsides for a while.  On the days I do not drink as much water, the blood appears again in large amounts.  Am worried that there is a serious problem undiagnosed and wondering what type doctor I should see and what test I should ask for.  My reg MD visits with office lab tests show blood frequently in the urine.  I've been to a Urologist many times and hopitalized on many occasions for stones and sometimes infection.  A stone is sometimes seen and sometimes not, but the bleeding persists off and on. Told one kidney is smaller.



My mother (86) has recently been diagnosed with bladder cancer.  Do I need to be concerned with my related condition?  How does one go about a thorough examination for proper evaluation to distinguish between the two?  Where is the best institution to go for a second opinion?  What do I need to bring?  Or, should I see a Nephrologist and go for a higher opinion?

by Kevin Pho, MD, May 16, 2003 12:00AM
Hello - thanks for asking your question.



You note persistant hematuria (blood in urine) despite an unrevealing IVP.  As you have stated, the one worry that you want to exclude is cancer or other kidney disorders.  



Other than the IVP, there are several other tests that would be more comprehensive.  These would include a cystoscopy, urine cytology and other imaging studies (such as an ultrasound or pelvic CT).  If all those tests are negative, then cancer can be reasonably excluded.  If you are continuing to have hematuria, then further evaluation with these tests are reasonable.



As for the best institution, it would depend on where you live.  I would suggest any large academic medical center.  You may also contact the American Board of Urology for more information:

http://www.abu.org/home.html



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

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