Persistent Blood in Urine After Catheterization: What to Do Next?

If your father has been experiencing continuous hematuria (blood in urine) for nearly three weeks after catheter insertion, it is crucial to seek medical attention immediately. Persistent hematuria can indicate underlying issues such as infection, trauma, or complications related to the catheter. A healthcare professional will need to evaluate his condition, possibly perform imaging studies, and conduct laboratory tests to determine the

Hello Dr.
Hsu,
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 bladder stone removal.
Since the cystoscopy procedure about three years ago, he has been experiencing discomfort in the bladder and a sensation of incomplete urination.
He has been taking traditional Chinese medicine, and our family did not realize it could be a problem related to urinary retention in the bladder.
Two weeks ago, my father began to experience 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 the Tzu Chi Hospital in Taichung for an examination, where it was discovered that there was 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.
The doctor mentioned this was a normal phenomenon and discharged him to rest at home.
However, on the way back to Miaoli, he began to experience severe pain and significant hematuria.
After having lunch at home, he felt unwell 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 Tzu Chi Hospital in Taichung, and I asked the doctor what to do about my father's ongoing hematuria.
The doctor explained that due to the bladder being severely distended for a long time, its sudden contraction could lead to persistent hematuria, which was normal.
However, I expressed that hematuria should gradually improve, and the doctor reassured me not to worry too much, stating it would get better over time.
Due to the hematuria, the urodynamic testing was postponed for another week.
I asked the doctor if it would still be possible to proceed with the testing if there was still bleeding after a week, and the doctor said it would be fine to do it then.
This reasoning seems questionable to me.
The doctor emphasized that the main concern should be whether kidney function could improve, and that the hematuria was not a cause for concern.
He only provided some medication for home care and advised us to return for a check-up in a week.
I feel helpless and wonder if there is any way to help my father improve his hematuria condition.
Since the outpatient visit, he continues to have persistent hematuria.
What should I do? Should I trust the doctors at Tzu Chi Hospital or seek a referral to another major hospital? I am truly worried.

colin, 30~39 year old female. Ask Date: 2008/09/20

Dr. Xu Weikai reply Urology

Hello, first of all, we should consider the severity of the hematuria.
Aside from the color, generally speaking, if the bleeding is more significant, blood clots will appear in the urine bag.
If the amount of bleeding is minimal, there will not be any clots.
If the bleeding is not substantial, there is usually no need for excessive concern; many patients with indwelling catheters experience some bleeding, which is often due to catheter-related infections or other forms of traction.
In such cases, observation is sufficient, and no special treatment is required.
Alternatively, some antibiotics and hemostatic agents may be administered.
However, if there is a large amount of bleeding, frequent blood clots, or even urinary obstruction, it is best to seek medical attention promptly.
This usually indicates a rupture of a major blood vessel in the bladder or prostate.
You can assess the bleeding situation yourself, and if you are truly concerned, you may consider transferring to another hospital for treatment.
If there are any unclear points, feel free to ask again for further discussion and research.
Sincerely, Dr.
Hsu Wei-Kai, Director, Urology Department, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2008/09/20

More Info

Persistent blood in urine following catheterization, especially in a patient with a history of kidney and bladder stones, can be concerning and warrants careful evaluation and management. Given your father's situation, it is essential to understand the potential causes of his symptoms and the appropriate steps to take.

Firstly, it is not uncommon for patients to experience hematuria (blood in urine) after catheterization, especially if there has been trauma to the urinary tract or if the bladder has been distended for an extended period. In your father's case, the prolonged urinary retention and subsequent catheterization could have led to irritation or injury to the bladder lining, resulting in bleeding. The fact that he has a history of bladder and kidney stones may also contribute to this issue, as stones can cause inflammation and damage to the urinary tract.

The initial response from the healthcare providers, indicating that the blood in the urine could be a normal reaction to the bladder's sudden decompression, is not unusual. However, persistent hematuria, especially if it is significant or accompanied by pain, should be further investigated. It is crucial to monitor the situation closely, as ongoing blood in the urine could indicate complications such as infection, bladder injury, or even the presence of stones that may not have been fully addressed.

Here are some steps you can consider taking:
1. Follow-Up Appointments: Ensure that your father attends all scheduled follow-up appointments, especially the one for urodynamic testing. This test can help assess how well the bladder and urethra are functioning and may provide insights into the cause of his symptoms.

2. Urinalysis and Imaging: If the hematuria persists, request a urinalysis to check for signs of infection, such as white blood cells or bacteria. Additionally, imaging studies like an ultrasound or CT scan may be warranted to evaluate for any residual stones or other abnormalities in the urinary tract.

3. Consult a Urologist: If you have concerns about the current management plan or if your father's symptoms do not improve, it may be beneficial to seek a second opinion from a urologist. A specialist can provide a more in-depth evaluation and may suggest alternative treatments or interventions.

4. Hydration and Monitoring: Encourage your father to stay well-hydrated, as this can help flush the urinary system and may reduce irritation. However, monitor for any signs of worsening symptoms, such as increased pain, fever, or changes in urine output.

5. Trust Your Instincts: If you feel that your father's condition is not being adequately addressed, do not hesitate to seek care at another facility. It is essential to advocate for his health and ensure that he receives the appropriate care.

In summary, while some degree of blood in the urine may be expected after catheterization, persistent hematuria should not be overlooked. It is vital to continue monitoring your father's condition, follow up with healthcare providers, and seek further evaluation if necessary. Your concerns are valid, and ensuring that he receives the best possible care is paramount.

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