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Having lower back pain, noticed blood and tissue in urine. How to overcome this problem?

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Practicing since : 1995
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Since yesterday I have varying amounts of blood in urine. Initial lower right back pain (had kidney stone 15 years ago) followed by blood in urine (koolaid). Passed 4" string looking like earth worm followed by tomato juice type blood in urine. No more pain but continued blockages followed by minor penis tip pain excreting addition small pieces of string looking like tissue blood appears koolaid again. No lower back pain but continued periodic blockages with pieces of worm or tissue appearance excretion while urinating.

I have additional photos that look wider than stringy secretion. Appears to be tissue. Still no pain. minimal if any blood in urine.
Posted Wed, 24 Apr 2013 in Urinary and Bladder Problems
Answered by Dr. V. Sasanka 46 minutes later
You need to have a few tests performed and the most basic is an ultrasound examination of your kidneys and bladder area. An x-ray of your KUB area also will be useful in the context of history of a kidney stone 15 years ago. Depending on what these investigations reveal, some other tests may be required.
I suspect a CT scan of your KUB will almost certainly tell us where is the source of bleed. If you have a stone which is 10 mm will almost certainly require intervention. Stones which are > 6 mm but < 10 mm might need some help in passing through the passage, and if associated with further episodes of bleed or pain, or if you were to develop a fever, it might become necessary to have them removed endoscopically.
I had a look at the pictures you have uploaded, and typically the long stringy clots suggest that bleeding has come from the tubes which carry the urine from the kidneys to the bladder (ureters). Bleeding from the bladder would be rather different.
Let me know if you have any doubts.
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Follow-up: Having lower back pain, noticed blood and tissue in urine. How to overcome this problem? 20 minutes later
Dr V. Sasanka,

Thank you for your prompt response. I'm concerned that I pass these strings or a few of them were wide like unfolded tissue. I'm waiting to receive an appointment with a urologist but not until next week. Is it safe for me to wait and not go to an emergency room? As I stated I have no pain but minimal tip of penis discomfort when urinating but only when passing these strings/pieces of strings so unless this were to change significantly I see no reason to go to the emergency room even though I continue to pass small pieces of string. The amount of blood seems to be reducing each time. I continue to consume 6 or more glasses of water daily.

Your thoughts?

Answered by Dr. V. Sasanka 11 hours later
The good thing is - no fever. If you had fever or if you were putting out so many clots that your urine was getting repeatedly stuck, you would be better off consulting at least an emergency room physician. Once in a while, when these clots are coming down the ureter, you could develop what we call 'clot cloic' - a pain similar to the one caused by a stone moving down from the kidney, and can be quite horrible.
If you can get to a hospital early, the advantage would be that you can get some kind of imaging done as early as possible like an ultrasound or CT scan, so we will have a provisional diagnosis with which we can work. If it does not look too serious, the consultation with the urologist can wait.
Obviously the more fluids you consume, the better as this will help increase urine production, help wash away any mild infection or debris and clots.
Glad to have been of help.
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