Navigating Urology Concerns: Seeking Guidance for Persistent Hematuria

Please guide me on what to do next..?

Hello, Director Lin...
I apologize for taking up your valuable time...
Please bear with me...
I am a helpless patient...
This month, I have been following up at a medical center in the south regarding hematuria that was detected seven years ago at Taoyuan Min-Sheng Hospital.
It started with blood tests, urine tests, followed by ultrasound, pyelography, and urodynamic studies.
Throughout this process, I initially tested positive for hematuria (which has been present for the past seven years since it was first detected at Taoyuan Min-Sheng Hospital).
Later, the doctors seemed unable to identify the cause of the hematuria.
After the pyelography, they found chronic cystitis (indicating that my bladder imaging showed blurred and irregular margins), which led to the arrangement of urodynamic studies.
When I went to review the report today, the doctor told me to follow up in six months.
I am very confused...
Why, despite the positive hematuria results and the diagnosis of chronic cystitis, along with the pyelography and ultrasound, is there still no identifiable cause? Why am I being told to follow up in six months...
wouldn't that just mean starting over? I have lost trust in this medical center...
Director Lin, what should I do...?

abeen, 20~29 year old female. Ask Date: 2007/06/18

Dr. Lin Hexing reply Urology

Hello, thank you for your inquiry.
I would like to address your question and provide the following suggestions: Regarding what you referred to as urinary occult blood, it is debatable whether the expenditure of energy and healthcare costs is justified.
Further investigation should be warranted only after confirming the presence of hematuria.
Generally, hematuria is defined as the presence of more than five red blood cells per high-power field under a microscope; if blood is not visible to the naked eye, it is classified as microscopic hematuria.
Conversely, if red blood cells are numerous under the microscope and blood is visible to the naked eye, it is termed gross hematuria.
The implications of these findings differ.
The most critical surgical issues related to hematuria involve urological concerns, such as tumors and stones.
Microscopic hematuria is less likely to indicate significant problems, while painless gross hematuria presents a much higher risk and should not be overlooked.
If hematuria is detected, further examinations are necessary, including urine cytology, intravenous pyelography, or ultrasound, and possibly cystoscopy, depending on the individual patient's situation and the physician's professional judgment.
Not every patient with hematuria will have a specific issue upon examination.
The prevalence of clinically significant diseases associated with microscopic hematuria is approximately 3.4% to 5.6%, while the detection of cancer ranges from 0% to 26%.
Therefore, the variability in reported findings is considerable and closely related to the patient's age and gender.
It is encouraging that no issues have been identified thus far; however, regular follow-up examinations are still essential.
It is generally recommended to conduct urine analysis and urine cytology every six months, and if any abnormalities are found, further investigations should be pursued.

Reply Date: 2007/06/18

More Info

Navigating the complexities of urology concerns, particularly persistent hematuria (blood in urine), can be quite distressing. Your situation, characterized by a long history of urinary issues, including persistent hematuria and a diagnosis of chronic cystitis, raises several important points that warrant careful consideration.

Firstly, it is essential to understand that hematuria can arise from various underlying conditions, ranging from benign to serious. Common causes include urinary tract infections (UTIs), kidney stones, bladder or kidney tumors, and even benign conditions like cystitis. In your case, the chronic cystitis diagnosis suggests that inflammation of the bladder could be contributing to your symptoms. Chronic inflammation can sometimes lead to intermittent bleeding, which may explain the persistent hematuria you've experienced over the years.

The fact that multiple tests, including blood tests, urinalysis, ultrasound, and pyelography, have not pinpointed a specific cause for your hematuria can be frustrating. However, it is not uncommon for hematuria to persist without a clear diagnosis, especially in cases of chronic conditions. The recommendation to follow up in six months is likely a standard approach to monitor your condition and ensure that any changes are noted over time. This is particularly important in urology, where some conditions may evolve or become more apparent with time.

While it is understandable to feel disheartened by the prospect of repeating tests, it is crucial to maintain open communication with your healthcare provider. If you feel uncertain about the diagnosis or the proposed management plan, consider seeking a second opinion from another urologist. A fresh perspective may provide additional insights or alternative approaches to your care.

In the meantime, there are several steps you can take to manage your symptoms and overall urinary health:
1. Hydration: Ensure you are drinking plenty of fluids, particularly water. Staying well-hydrated can help dilute your urine and may reduce irritation in the bladder.

2. Dietary Considerations: Certain foods and beverages can irritate the bladder and exacerbate symptoms. Consider reducing your intake of caffeine, alcohol, spicy foods, and acidic foods, which may help alleviate some discomfort.

3. Monitoring Symptoms: Keep a detailed log of your symptoms, including the frequency and characteristics of hematuria, any associated pain, and other urinary symptoms. This information can be invaluable for your healthcare provider in assessing your condition.

4. Follow-Up Care: Adhere to the follow-up schedule recommended by your healthcare provider. Regular monitoring is essential, especially in cases of chronic conditions.

5. Consider Lifestyle Modifications: If you smoke, consider quitting, as smoking is a risk factor for bladder cancer. Additionally, maintaining a healthy weight and engaging in regular physical activity can contribute to overall health.

6. Explore Additional Testing: If your symptoms persist or worsen, discuss the possibility of further diagnostic testing with your healthcare provider. This may include cystoscopy (a procedure to look inside the bladder) or additional imaging studies.

In conclusion, while the journey through persistent hematuria can be challenging, it is important to remain proactive in your care. Engage in open discussions with your healthcare team, consider seeking a second opinion if needed, and take steps to manage your urinary health. Remember, you are not alone in this journey, and there are resources and support available to help you navigate your concerns effectively.

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