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Noticed Blood During Urination. Had Painful Kidney Stones. What Do You Recommend?

Posted on Thu, 21 Nov 2013

Question: For past two days I have noticed blood twice on urinating. Last night it was fresh. Scared me. First time yesterday maybe with a tiny clot? Had urinalysis today and everything was normal including WBC's and RBC's. No infection and blood level was less than 1 on scale of 1-5. Urine today is clear. Drinking a lot of water. Seeing my urologist Monday. His office ordered a urinalysis yesterday but turned out it was just for a culture so that is why I went in today for the complete urinalysis. I had a painful kidneys stone 11 years ago, first and last time. I am 63 and have BPH and have taken Flomax for 5 years now. My PCP says to avoid surgery for it for now. My dad is 90 and has stage 3 kidney disease but it is in check. He had bladder stones in his 60's. Do you have any hit on all this? Thanks.

Answered by Dr. Rhea Chanda (42 minutes later)

Brief Answer: Some testing is required Detailed Answer: Hello sir, Thanks you for the query. Blood in the urine can be due to infection, stones or malignancy. In your case, since the urine analysis shows no trace of RBCs and occult blood,as you have stated, there is a possibility that a transient clot or two was discharged. This would have been possible if a small stone was passed. In case of infection, there would have been Rbcs or bacteria in the urinalysis. There may have been a small stone foci that was discharged in the passage of the urine when forceful urination occurs. BPH should not cause this. i suggest that you drink plenty of water(at least 3-4 lit) a day so that your bladder may be washed out. You do have a similar history in the past. But this also needs to be evaluated, since you have family history of kidney disease. I would recommend a kidney function test, repeat urinalysis after 2 weeks, and a scan of the KUB to start with,and a cystoscopy if needed.Since you are seeing your urologist soon, you can consult with him about the tests. Hope I have answered your question, please feel free to ask me if you have further concerns. Wishing you speedy recovery. Regards,

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Rhea Chanda (1 hour later)

Thank you for your prompt reply. So it sounds like either a stone(s) or malignancy? I hope the former. Is it possible to pass a stone without feeling it? I never did feel the first and last kidney stone pass in 2002 but it sure hurt like heck. They spotted it on an X ray I was in a. Lot of pain. I am not in pain now. If it is a malignancy would that show up in the urinalysis. The nurse today on the phone seem to think the blood cells would have indicated something out of whack and they were normal. Thanks, XXXXXXX

Answered by Dr. Rhea Chanda (6 hours later)

Brief Answer: dont worry Detailed Answer: Well XXXXXXX I don't think it's malignancy yet. The history is too short and transient. Urine analysis won't show that. But a scan and cystoscopy will. I'm not saying it's malignancy yet, but it never hurts to check it out since you have family history of kidney disease. Yes, often stones pass with out one realizing it. Just depends on the size and location. Don't panic yet. See your urologist first. Follow up with the tests and then lets proceed from there. Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Rhea Chanda (1 hour later)

Thank you Dr. C, I think I may have bladder stones. After more than the usual water intake today I am urinating a lot and can't empty the bladder. Worse than my normal BPH. I have to change positions to relieve urine. I went three times at the restaurant this evening. Maybe a stone is partially blocking the urethra. No visible blood in 24 hours in my urine. Hopefully no pain before Monday's appointment with my urologist. I suspect he will want to sirgically treat the BPH to prevent this from happening again. I have put it off out of fear of the risks and retrograde ejaculation. I will tell my urologist this. It is somehow easier over the Internet. : ).My time with you will run out before Monday morning. I appreciate your well wishes. I hope the doc can do the scans next week and if stones break them up so I can urinate better and then must decide on TURP or ? Thanks for being a good listener. I've learned from you and found some reassurance and good advice. XXXXXXX

Answered by Dr. Rhea Chanda (35 minutes later)

Brief Answer: wish you well Detailed Answer: Thank you XXXXXXX . This problem of urination can definitely be due to the BPH . I think that whatever small stone you may have had has passed out . And your current urination problem is due to the B.PH. TURP is commonly done nowadays to manage that with minimal complications . I'm sure your doctor can definitely explain it to your satisfaction . Wish you good health and a speedy recovery .

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Above answer was peer-reviewed by : Dr. Prasad