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Urology/blood in urine

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Question
Hello, I am a 44 year old male live in Wyoming (Cheyenne)I am on several medications (Risperidone, Citalopram, Xanax, Glyburide, Simvastatin, Terazosin).  Recently they did a urinalysis and found moderate amount of microscopic blood in my urine.  I have previous had a similar problem but it was on trace amounts.  They did a cystoscopy at that time and found nothing.  That was about 2 years ago.  
So they referred to a urologist again and I have an appointment on the 23rd.
I have pain in my groin area and sometimes in my penis and it is not when I urinate.  The pain is almost all the time.  
I am just wondering what to expect at my next appointment and what are some of the things it could be.  I am very nervous and scared about this.  Thank you for your time in looking at this.  It is very much appreciated.

Answer
John, the constant pain in the groin (and sometimes penis) can be due to many things but it is unlikely that it is related to the blood in your urine.  Urinary stones impacted in the lower ureter may produce blood in the urine & also  pain in the groin and penis but this is typically quite severe, colicky in nature and it radiates to the testicle and flank.  What you are describing does not fit this pattern.  The most likely causes are hernias, muscle strain, and referred discomfort to the area from pelvic organs (prostate, bowel, etc. ).  You need to have the blood in the urine evaluated and if nothing is found to explain the discomfort, your doctors can pursue other possibilities.  

Although red discoloration of the urine is usually due to blood, it may also occur from the excretion of some pigments in the foods we eat.  The most common are from beets, rhubarb, & blackberries.  Certain medications & chronic toxicity from lead or mercury may produce red urine as well.

There are many possible causes for blood in the urine (hematuria).  The origin of the bleeding can come from the upper (kidneys or ureters) or lower (bladder, prostate, urethra) urinary tract.  Blood seen only under the microscope (microscopic hematuria) is usually of a benign nature whereas gross hematuria is potentially more serious. With gross hematuria, it is important to note the relationship of the bleeding to the urinary stream.  If at the beginning of urination (initial hematuria), the source of the blood is almost always in the urinary canal (urethra).  If at the end of urination (terminal hematuria), the source is usually the prostate gland in men or the bladder neck in men and women.  Bleeding throughout the entire stream (total hematuria) is due to bleeding that is initiated in the urinary bladder or upper urinary tract (kidneys and/or ureters).  

Some of the common causes of hematuria include infection, tumors, stones, and trauma (injury).  In order to look for the cause, it is necessary to consult a urologist.  A history, physical examination, urine cytology, and other laboratory tests are done.  In recent years, the FISH assay of the urine has been used in lieu of or in place of the urinary cytology.  This test has proven to be much more sensitive and specific in detecting bladder cancer in voided urine specimens or bladder washings. Visualization of the kidneys by imaging studies (ie IVP, ultrasound, CT or MRI) and examination of the lower urinary tract with a cystoscope are usually required.  

In 80% of patients with microscopic hematuria a cause is found and  2-3% of these are  found to have a urologic cancer.  Microscopic hematuria can also be due to inflammatory disorders of the kidney, so called nephritis, of which there are many types. Even with studies, often no specific cause is found (in about 20%) for microscopic hematuria and this is termed “essential hematuria”.  The American Urologic Association has recently revised their guidelines for the evaluation of  microscopic hematuria.  This is defined as 3 RBC or greater per high power field in at least 2 of 3 properly collected specimens.  If no cause is found for the hematuria on initial evaluation, the patient is periodically re-evaluated & followed for 3 years.  If the patient remains stable for 3 years, routine followup is no longer recommended.   The exceptions would be those persons with increased risk factors for cancer such as smoking, history of gross hematuria, irritative voiding symptoms, exposure to chemicals or dyes (benzenes or aromatic amines), urinary tract infections, history of pelvic irradiation, analgesic abuse, and age greater than 40. 

In summary, consultation with a urologist (as you have scheduled) is needed to determine the cause and seriousness of the hematuria.  Good luck!

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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