Gross Hematuria Unknown cause

[dyykjt1]

I am a 55 yo female with a history of gross hematuria. I first had gross hematuria in May of 07. 1 occassion on a Sat. and 1 occassion on the following Sunday. After and in between these two episodes, urine was clear with no visible blood. I went to my Primary care physician who ran a U/A that did not show any blood at all. We did these follow up U/A's for 3 more times and all were clear. He then referred me to a Urologist and scheduled me to have a Renal Ultrasound prior to my visit with the Urologist. The Renal Ultrasound was normal with the exception of a dilated ureter on the left. My Primary Care physician then sent me for a Abdominal CT Scan with and without contrast. The CT scan showed a Horseshoe Kidney, but no other abnormalities. I later had my visit with the Urologist who scheduled a Cystoscope. The Cystoscope was good, no abnomalities seen. I had one very slight episode of gross hematuria approximately 5 months later for 1 time after jogging. No more hematuria until 3 months later (this past weekend) when I had gross hematuria on 3-4 different occassions on both Sat and Sunday with the hematuria clearing up and has not reappeared. I had been taking over the counter Cold medicine for several days. I was being re-evaluated for the Hematuria and had a repeat CT scan w and w/o contrast as well as a KUB with and without contrast and post void on Monday before these last episodes of hematuria. They were compared to my last test and showed no change. I am had my 2nd Cystoscopy on Monday Feb. 18th which was clear and the urine that was tested during the Cysto was negative for blood. My urologist has no clue what is causing the intermittent or recurring gross hematuria. I feel that this has been checked out extensively, but want to know if you think that I should try and do further testing for this mystery?

TIA for you help
dyykjt

[Fernando Roque, MD]

Hi.  Have your doctors checked for a possible gynecologic source of the bleeding? Sometimes blood coming from the vaginal canal gets admixed with urine when voiding.  Maybe the blood isn't coming from your urinary tract at all.   Another thought: have your doctors checked if you have any blood problems (e.g. abnormal bleeding parameters)? This might be another possibility worth pursuing.

[dyykjt1]

Dr. Roque
Thank you for your reply. No my urologist has not considered a gynecologic source for the bleeding. I have an appointment for my yearly physical with my gyn next Thursday and I will discuss this with him. I also have not had any test to check for abnormal bleeding parameters. I will check into this also.

I have been considering a second opinion, but I have had all the test to investigate hematuria. I do not know whether a second opinion would bring any additional info into this or not. Do you think I should get a second opinion from another urologist or should I wait until after I have investigated this from a gynecologic veiwpoint?

Thank You
dyykjt1

[Fernando Roque, MD]

Hi.  If your urologist is at his wit's end, try to get a second opinion from either a gynecologist or an internal medicine specialist/ nephrologist.  Maybe they can see the problem from a new perspective.  Anyway, I hope that whatever it is, it's not anything serious. Good luck.

[dyykjt1]

I have followed your advice and had a complete gyn exam. Every thing was normal with no problems. I also have had extensive blood work done which is all normal. No bleeding problems. All test are normal.

I have obtained a second opinion from my gyn and from my primary care physcian who is an internist and they both agree with my urologist that this is benign hematuria that needs to be followed closely.

I have an appointment with my urologist again in August for a complete checkup.

Do you agree with this course of action?

Thank You
dyykjt1

[Fernando Roque, MD]

Hi.  Since you have had an extensive work-up and all the tests have not yielded anything significant, then I would have to agree with the present course of action.  Benign hematuria is a diagnosis of exclusion, and I am not comfortable giving such a diagnosis.  However, all your tests have come back normal, so I would agree to just observe for the meantime and just do additional tests if an episode of hematuria occurs again.  

[dyykjt1]

What other additional test would you recommend should the hematuria episodes continue?

Thank You for your help
dyykjt1

[Fernando Roque, MD]

Hi.  Your doctors can do a urinalysis with RBC morphology, if they have not done this already.  This test can identify if the blood in the urine is coming from the kidneys itself or  from lower down in the urinary tract (e.g. bladder, ureters).  A repeat cystoscopy may also be warranted if the hematuria episodes continue.  Your doctors may also want to consider testing the urine for tuberculosis.  This is a relatively rare condition, but blood in the urine with no apparent cause is sometimes an initial symptom of genitourinary tuberculosis.