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Have kidney failure and heart failure. On medication. Noticed bleeding from penis. Proper diagnosis?

Apr 2013
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My father is 82 years old. He has mild-moderate kidney failure and heart failure (NYHA Class I-II). He has taken 4 days worth of cefuroxime at 250mg twice daily for aspiration pneumonia, and has 3 more days worth of antibiotics to complete the course. Today, I have helped my father to do his personal hygiene after going to the toilet, and I have noted my father has some blood spots in his diapers. When I have wiped his genitals, I have noticed some blood coming out from the inside of his penile sheath. My father has increased frequency of nocturnal urination, has no pain when urinating, no fever (because he is being treated with cefuroxime) but has body aches and pain. He is currently doing a physiotherapy program for rehabilitation (reconditioning after a long protracted hospital stay). My question is: I am concerned about the bleeding from the penis, I would like to know if this is a prostate checked a couple years ago and it was fine. He also has a bladder ultrasound 2 months ago, and this shows my father has completed emptying his bladder when voiding. Could you please advise what conditions my father is suffering from? (We have cephalexin and amoxycillin antibiotics at home from the previous prescriptions for my father). Thank you for your help.
Posted Sun, 14 Apr 2013 in Kidney Conditions
Answered by Dr. Ivan R. Rommstein 3 hours later
Hi and welcome to XXXXXXX

Condition you are describing is called macrohematuria andit means that there is some cause of bleeding in between kidney and urethral opening. It is common at his age and can be related to kidney failue especially if failure is caused by diabetes. Other most common causes are urinary infections(kidney,ureter, bladder or urethra, symptoms are ain while urinating, chills,fever),ureteral stones(very often cause, especially if he experience pain in lumbar area) or any kind of penile or lumbar trauma. More serious diagnosis such as tumors or abscesses are less common but always must be ruled out. If his symptoms persist he should do more specific tests than ultrasound. BAsic urine and lab tests can show signs of infection and red blood count status.
Hope I have answered your query. If you have any further questions I will be happy to help"
Above answer was peer-reviewed by
Follow-up: Have kidney failure and heart failure. On medication. Noticed bleeding from penis. Proper diagnosis? 30 minutes later
I have forgotten to add that my father has NIDDM. My father has symptoms of bleeding in the diapers before, and I have found blood in his penile sheath when I have helped to clean my father on other occasions. On these occasions, my father was taken courses of antibiotics for respiratory tract infections, and the penile bleeding went away. My father expresses pain in his shoulders and his legs when exercising, and after thorough questioning, he said he may experience some burning when urinating. My father's nephrologist has mentioned about hematuria when blood was detected in the urine sample about a year ago, and cystoscopy was mentioned, but my father has been in and out of hospital for other treatment so the procedure never went ahead. I shall take my father to see the family doctor tomorrow to get a blood test and urine test for the nephrologist. Your answer is very insightful but I am a little bit worried from it. Which physician should I take my father to see after seeing the family doctor tomorrow, and whether the additional information has helped to direct me to a firmer path? Thank you for your help.
Answered by Dr. Ivan R. Rommstein 49 minutes later
Hi. You shouldnt be worried.Nothing serious will happen at once,so you have time to follow his complains and do further tests.
Pain in shoulder and legs can be refered pain from urogenital disorders but also many other factors can cause that(heart disease,osteoporosis,diabetes...) ,it is hard to say the exact diagnosis without more info. Also diabetes can affect nerves and make it less sensible to pain so he doesnt need to complain about pain while urinating. Diabetic glomerulonephritis can cause hematuria and diabetes makes people more sensitive to all kind of infections.

I suggest you to do cystoscopy and urography. If anything is found some endoscopic procedures can be done. You should visit urologist and nephrologist both. They can examine genitals and find is there maybe some cause in penis or preputium and do tests i ve mentioned. You must know that hematuria isnt problem for itself. It is just a sign. Man cant bleed out from it. The most important thing is to save kidneys adequate function and check urea and creatinin level frequently.
Do these lab and urine tests and ask your GP is there any abnormalty(blood in urine, bacteria, leucocytes, nitrats or glucose levels).
Above answer was peer-reviewed by
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