Dear J. Patterson,
Hematuria, blood in the urine, may come from the kidney, ureter, bladder, prostate or urethra. The cause may be due to infection/inflammation, stones, cancer, prostatic varices, sickle cell disease, or renal parenchyma lesions or glomerulopathy. The evaluation consists of a history and physical exam, a urine analysis culture and sensitivity, urine cytology, serum electrolytes, an imaging study of the kidney and ureters (CT/IVP/Ultrasound) and a cystoscopy to evaluate the urethra, prostate and bladder.
From your history of gynecological cancer in the past, this may represent recurrence of the cancer with invasion into the urinary bladder. It does not sound like kidney stones which, as you stated, can be quite painful. You have painless gross hematuria with clots which makes me suspect the bladder as the source. Did you have a follow-up CT scan? What did it show? Do you pass air when you urinate? Do you leak urine? How long ago was your surgery? Did you have radiation/chemotherapy treatment as well? Were they able to remove all of the cancer? Was the pleural effusion related to the cancer? These are the questions you should present to your physician. Follow up with a Urologist is warranted.
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians' notes and lab test results that you may be able to obtain. These will help us greatly.