AboutStephen W. Leslie, MD Expertise Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.
Experience Full time practicing urologist with 20 years experience. Assistant Clinical Professor of Urology at the Medical College of Ohio. Editor in Chief of eMedicine Urology internet textbook. Author of only book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.
Organizations American Urological Association, Ohio State Medical Association, Sexual Medicine Society
Publications Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.
Education/Credentials Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison
Awards and Honors Thirlby Award of the American Urological Association.
Expert: Stephen W. Leslie, MD Date: 8/27/2008 Subject: Surgery for cancer of the bladder and prostate
Question Dear Stephen,
I hope you can give me some answers. My husband Bob was diagnosed with bladder cancer in December 2007. The Surgeon recommended he have the bladder surgically removed and also the prostate. Because he had a heart bypass 18 years ago he suggested that he have his heart checked out before any surgery was performed. He did this and he was told that he needed to have two stents put in his chest. On 3rd April 2008 he had the surgery performed to remove his bladder, his prostate and they also took one of his kidney's as there was a shadow on the MRI scan and they thought it might be cancer. As it turned out there was no cancer in the kidney. He now has an urostomy bag to catch any urine. Unfortunately the stents that he had put in collapsed during the surgery. He was recovering well and went in to have three more stent's put in his chest the middle of June. He is taking Aspirin and Plavix to keep his blood from clotting. At the end of June 2008 he noticed blood coming out of his penis. He also noticed a pain and a feeling of something hanging down in the area between his penis and his anus. He has great difficulty sitting down and standing or walking for more than a few minutes. I brought him to the hospital eight weeks ago and they took an x ray, CT scan and MRI scan. They said that there was nothing sinister showing up on any of these. The bleeding got worse and the clots got bigger. He has received 2 pints of blood nearly every week he has been in hospital. They have tried a number of procedures to stop the bleeding, but none have worked. He was in Hospital for 7 weeks (he came home last Saturday, and they said that they cannot find what the problem is. They think that it might be a vein that is bleeding and because of the blood thinners it is not healing properly. They took him off plaxiv and put him on heparin for two weeks. The bleeding slowed down quite a lot. However when they introduced Plavix again the bleeding started. The bleeding is not as bad as it was, but it is still there. The hospital say that if his bloods go back down they will give him more blood transfusions. They say that they cannot do anything about the pain and discomfort that he has because they do not know the cause. Please can you let me know if you have ever heard of anything like this, and if you have any answers to his situation. He has also lost a lot of weight since the operation. Thanking you in anticipation of your answer
Margaret Carroll
Answer Margaret:
I'm sorry, but this is a complicated situation and it sounds like he's been getting good treatment for a difficult problem. Angiography ought to be one consideration. Blood coming from the penis would be unusual after a cystectomy. A cystoscopy might be reasonable but probably would not show anything.
This is a tough, tough case. A second opinion from another urology group or institution can be an option. Nobody will question a second opinion in a difficult case like this.
