Question to GP Maarten: Blood in my urine
Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand and writes about medical facts.
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Dear Martin,
I am a man, 57 years old, 1m72, 65 kg, non-smoker, alcohol max 1 or 2 units/day. Medical past:
- high cholesterol (>10 years), now take 40mg of Bestatin daily.
- at checkup (3 years ago) traces of protein and blood in urine.
- 3 years ago, diabetes started, but now under control (?) by heavy diet (low carb). HBA1C last year 5,3 (previously 6,9).
- my blood pressure is usually normal (last week 112/75), but may be elevated mi due to stress (results) or coffee in the morning (up to 145). Normally under 130.
Sorry for the whole story, but I really can't shorten it…
About 4 months ago I suddenly suffered from (a lot of) blood in my urine, without pain (painless hematuria).
The first day only brown (old) blood, later fresh blood. After 2 days to a local hospital. The doctor laughed at first and said kidney stones, but no pain and no sign of kidney stones on X-ray. Then I made an ultrasound and the doctor saw a “white” tumor (2,5 cm) in my right kidney. Received a blood coagulant and a course of antibiotics (4 days). Bleeding stopped immediately.
The advice was to go to a larger hospital, preferably the day after… I then went to the university hospital in Khon Kaen 2 days later. The doctor there also saw something white in my kidney, but according to him not dangerous, because tumors are black on an ultrasound. Nothing else to see with echo.
Then had to come back for a cytoscopy and a CT scan (2,5 months waiting time after vacation, or immediately in a private clinic, 3x the price). At the cycstoscopy nothing was visible in my urinary tract, no enlargement of the prostate (also PSA normal), only a few red spots (like abrasion) in my bladder. Biopsy taken. Didn't get the result until much later, due to IT problem. Turned out something like “urotelial proliferation unknown malignant potential”. According to the doctor not really to be worried, because nothing strange to see on cystoscopy and if it was really malignant it would be there.
The CT scan showed nothing in my kidneys, nothing in my bladder or elsewhere… everything nice and white.
According to the doctor, I now have to come for a check-up every 6 months for urinalysis (creatinine always 95) and in 2 years a new cystoscopy and CT scan.
In the meantime I continue to suffer from a little blood loss, yellow or sometimes orange urine (sometimes up to 5RBC).
My doctor (a urologist) has been training for 4 months now, but I am still left with a few questions:
- Did the doctors act correctly with examinations? Or can more happen? Is waiting the best choice? I have confidence in the doctors here, especially in Srinagarind hospital. Specialists often speak very good English and it is not expensive, especially compared to private hospitals. You have to wait more often.
- Could massive bleeding in my urine be due to a nonexistent/incipient bladder problem? Or rather from the kidneys? And why then still bleeding if my kidneys are healthy (says the doctor)?
- How can a “white” tumor in the kidney just disappear after 2/3 months? Or is that not visible on a CT scan (because it also includes X-ray technology).
- Is there anything I can do to prevent worse besides drinking lots of water?
Yours faithfully,
E.
*******
Dear E,
Thanks for the detailed information. I take it you don't take any other medication besides the Bestatin? By the way, you can leave out the Bestatin. Can be a (partial) cause of the diabetes.
As for the bleeding you have had and are still having to some extent, it is most likely due to a bladder problem. A coagulant only works if no major vessel is involved in the bleeding. Moreover, it is not a harmless treatment.
Red spots in the bladder wall can indicate a CIS (carcinoma in situ) and it is wise to continue to monitor it. That is why I would prioritize a cytoscopy with biopsy and not wait two years.
Ask if the biopsy can be evaluated by three different pathologists. This reduces the average error to about 3%.
A tumor that just disappears is often based on an artifact, in other words, never existed.
So my advice is actually to repeat the cytoscopy and to be sure by another urologist. Then you have a real second opinion. You can't do much else.
Yours faithfully,
Dr. Maarten