Persistent Blood in Urine: What to Do When Facing Urological Issues?

What should I do if I have persistent hematuria?

Hello Dr.
Liu,
My father is a 63-year-old patient with kidney stones and bladder stones.
He has undergone extracorporeal shock wave lithotripsy for kidney stones on both sides three times, as well as cystoscopy for stone removal.
Since the cystoscopy procedure about three years ago, he has been experiencing discomfort in his bladder and a sensation of incomplete urination.
He has been taking traditional Chinese medicine, and our family did not suspect that it could be a problem with urinary retention in the bladder.
About two weeks ago, my father began to experience lower back pain, which he thought was a strain.
He continued taking traditional Chinese medicine without improvement.
Eventually, the pain became unbearable, and he went to Taichung Tzu Chi Hospital for an examination, where it was discovered that he had significant urinary retention in both the kidneys and bladder.
His kidney function had deteriorated due to prolonged urinary retention, nearing the point of requiring dialysis.
The doctor initially placed a urinary catheter for a week and scheduled him for urodynamic testing.
At first, the catheterization produced normal urine output, but the second bag showed slight hematuria, which the doctor said was a normal phenomenon.
After the outpatient visit, he returned home to rest.
However, on the way back to Miaoli, he experienced severe pain and significant hematuria.
After having lunch at home, he felt something was wrong and went to the emergency department at Hsinchu Mackay Memorial Hospital, where he was admitted for four days.
The doctors there indicated that the hematuria would gradually improve, but after discharge, he continued to have persistent hematuria.
On the third day after discharge, we returned to the outpatient clinic at Taichung Tzu Chi Hospital, and I asked the doctor about my father's ongoing hematuria.
The doctor explained that the bladder, having been severely distended for a long time, would contract suddenly, leading to persistent hematuria, which was normal.
However, I expressed that hematuria should gradually improve, and the doctor reassured me that it would get better over time and not to worry too much.
Due to the hematuria, the urodynamic testing was postponed for another week.
I asked the doctor what would happen if there was still bleeding after a week, and the doctor said it would be fine to proceed with the testing at that time.
This reasoning seems questionable to me.
The doctor mentioned that he was more concerned about whether my father's kidney function would improve rather than the hematuria issue.
Therefore, we only received some medication and were advised to rest at home, with plans to return for a check-up in a week.
I feel quite helpless and wonder if there is no way to improve my father's hematuria condition.
Since the outpatient visit, he continues to experience persistent hematuria.

What should I do? Should I trust the doctors at Tzu Chi Hospital, or should I seek a referral to another major hospital? I am genuinely worried.

colin, 30~39 year old female. Ask Date: 2008/09/19

Dr. Liu Jianting reply Urology

It's really tough.
I've handled a few similar cases myself, and I believe the current physicians can manage it well!

Reply Date: 2008/09/19

More Info

When dealing with persistent blood in urine, particularly in a patient with a history of kidney and bladder stones, it is crucial to understand the underlying causes and the appropriate steps to take. Your father's situation, characterized by ongoing hematuria (blood in urine) after undergoing multiple procedures, raises several important considerations.

Firstly, it is essential to recognize that blood in urine can stem from various sources within the urinary tract, including the kidneys, ureters, bladder, or urethra. Given your father's history of kidney and bladder stones, the presence of blood could be related to irritation or injury caused by these stones, especially if they have caused any trauma to the urinary lining. Additionally, the recent urinary retention and subsequent catheterization may have exacerbated the situation, leading to inflammation or minor trauma that could result in bleeding.

The fact that your father has experienced discomfort and a sensation of incomplete bladder emptying for an extended period suggests that there may have been underlying issues, such as bladder outlet obstruction or chronic urinary retention. This can lead to bladder wall distension and subsequent complications, including urinary tract infections (UTIs) or even damage to the bladder and kidneys over time.

In terms of management, it is crucial to follow up with a urologist who can perform a thorough evaluation. This may include imaging studies, such as a CT scan or ultrasound, to assess for any residual stones, strictures, or other abnormalities in the urinary tract. A cystoscopy, which involves inserting a camera into the bladder, can also be beneficial in visualizing the bladder's interior and identifying any sources of bleeding.

Regarding the ongoing hematuria, while it is not uncommon for blood to persist temporarily after catheterization or bladder manipulation, it should not be ignored, especially if it is significant or worsening. If the bleeding does not resolve or if your father experiences increased pain, fever, or other concerning symptoms, it is imperative to seek immediate medical attention.

As for your concerns about the care your father is receiving at the current facility, trust in the medical team is vital. However, if you feel that your father's condition is not improving or if you have doubts about the management plan, seeking a second opinion from another urologist or a larger medical center may provide additional insights and options for treatment.

In summary, persistent blood in urine, especially in a patient with a complex history of urinary issues, warrants careful evaluation and management. It is essential to work closely with healthcare providers to ensure that all potential causes are investigated and treated appropriately. If necessary, do not hesitate to seek further opinions to ensure that your father receives the best possible care.

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