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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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AM a 44 year old male.I was told i had

Answered by
Dr.
Dr. Anders Mark Christensen

General Surgeon

Practicing since :2016

Answered : 1078 Questions

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Posted on Tue, 5 Mar 2019 in General Health
Question: AM a 44 year old male.I was told i had microscopic haematuria at an A&E appointment for an unrelated matter in c. 2015. I forgot to follow it up. Fast forward to September 2018 and I was experiencing pain in lower abdomen. Started in bladder area and then migrated (or referred to epidimimis and prostate area). Before urinating had feeling of fullness in bladder and then sharper stinging sensation in bladder after urinating and sometime stinging sensation in urethra. Also dull groun pain in sitting and walking. Pain was at times nauseating, such as given by testicular pain. No increased urgency, problems with flow or noticeable increased frequency. Saw GP, dipstick showed significant microscopic haematuria again, no sign of infection on dipstick. Referred for USS and PSA test: both negative. Saw urologist for 2nd opinion. He was confident that the symptoms were not those associated with malignancy. Prescribed antibiotics and pain stopped within a week. Fast forward 5 months - which have been completely pain free- the same symptoms have returned and dipstick test again shows same results. Gp seems confused and is going down the antibiotics route again. Any suggestions?
doctor
Answered by Dr. Anders Mark Christensen 51 minutes later
Brief Answer:
Have you had a cystoscopy and CT scan?

Detailed Answer:
Hi Richardavis,

Have you had a cystoscopy and a CT urography scan? These should be the next investigations considering your symptoms and history. Looking forward to hearing you.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Anders Mark Christensen 27 minutes later
I haven’t. My urologist last September felt that the cystoscopy was not required as the symptoms were not indicative of cancer.
My gp seems of the same view, especially given normal USS and the asymptomatic period.
doctor
Answered by Dr. Anders Mark Christensen 15 hours later
Brief Answer:
I agree

Detailed Answer:
Hi again,

I agree, given that you have had an asymptomatic period and a normal ultrasound. However, I find a cystoscopy is relevant if you have persistent hematuria.

Best wishes.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Anders Mark Christensen 22 minutes later
Hi
Final question.
If it was a cancer, from reading about the symptoms, it looks like it may be more likely to be CIS. I’ve read that cystoscopy isn’t a good test for this, and urine cytology is the best diagnostic for this.
Should I request this as well?
Many thanks
doctor
Answered by Dr. Anders Mark Christensen 9 hours later
Brief Answer:
Urine sample collected during cystoscopy is a good idea

Detailed Answer:
Hi again,

Yes a urine sample for cytology, preferably collected during a cystoscopy, will help increase the sensitivity of the diagnosis.

Best wishes.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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