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Question
73 year old male caucasian had plasma button surgery for BPH Jan 2012.Resumed taking blood thinner, dabigatran a week after surgery.In July2012 changed blood thinners from dabigatran to 20 mg rivaroxaban. All went well until I lifted heavy weights May2013 resulting in blood in urine. Urologist ordered a CAT scan of lower abdomen and performed cystoscopy. Both test were negative for cancer. He ordered 10 days of Bactrim and 2 days per week of Avodart. After a month I had to stop taking Avodart due to breast enlargement. Over the past 10 months hematuria occurs whenever I lift anything over 35 lb or apply a lot of pressure to lower abdomen. The occurences average at least once per month and the hematuria clears up within a day or two. It seems unlikely that wound will heal by itself as long as I'm on blood thinners.Other than another surgery, what options are available to me to heal the inside of the prostate? Have you ever heard of hyperbaric treatment being effective to hasten the healing of such a wound? Thank you in advance for your valued opinion.

Answer
John:

First, it needs to be clear where the blood is coming from.  It would be unusual for the bleeding to be coming from the prostate without some indication of it on cystoscopy examination.

A short course of radiation therapy can sometimes help control bleeding.  This usually involves just minimal radiation not full therapy for cancer.

I doubt hyperbaric therapy will work since we are not dealing with any of the known processes or disorders where this will work.  As long as you are on blood thinners, you are at increased risk of bleeding.  

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Stephen 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 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved 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. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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