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What causes blood clots in urine?

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General & Family Physician
Practicing since : 2010
Answered : 3312 Questions
Question
ADDITIONAL INQUIRY… STILL SUFFERING FROM BLEEDING & CLOTS IN URINE…COMES & GOES…ALL I CAN DO IS DRINK A LOT OF WATER.. TESTS HAVE BEEN MADE TO BLADDER; KDNEYS, INR, HAD BLADDER CAUTERIZATION; HAD EXTERNAL BEAM RADIATION IN PAST FOR PROSTATE CANCER; RADIATION CYSTITUS;…
HAD BELLS PALSY; URINE RETENTION; HEMATURA;BESIDES RADIATION HAD ZOLADEX INJECTIONS. XXXXXXX MEDICATIONS AVAILABLE OR PERHAPS TAKING TOO MUCH MEDICATIONS? ANY STUDIES ON THIS PROBLEM?ARE THERE SPECIALISTS IN THE FIELD FOR THIS PROBLEM? I AM AT A LOSS.
Posted Mon, 1 Sep 2014 in Cancer
 
 
Answered by Dr. Suresh Heijebu 4 hours later
Brief Answer:
Consult Radiation oncologist,Interventnl Urologist

Detailed Answer:
Hi sir,

I have carefully read your query and understand your concern.

Passing blood clots in urine can be really a devastating problem i understand.

The most likely cause of this urinary bleed/hematuria in your case could be largely Intractable Hemorraghic cystitis(radiation induced) in my opinion coupled with a possible minor role of relapsed prostatic carcinoma.

This should be carefully evaluated through blood investigation-PSA(prostate specific antigen),which is an excellent tumor marker capable of predicting tumor recurrence.

Of course you are on a wonderful drug Zoladex ,which is quite good in preventing the relapse of prostatic ca.

Radiation cystitis not responding to bladder cauterization can respond well to injection of sclerosing injections of 1% Ethoxysclerol into the bleeding areas.

Hyperbaric oxygen therapy-HBO and Pentoxifylline are newly approved therapies for intractable/resistant radiation hemorraghic cystis.

I strongly recommend you to use radioprotective agents like DMSO-dimethyl sulphoxide next time in case you case have radiation therapy.
This can prevent any new radiation induced bladder injury.

kindly consult the afforesaid treatments with your treating physician.

You are currently not receiving any excess drugs.
You need to consult expert doctors who have mastered in Radiation Oncology and Interventional Urology to deal with your current health issue.

I hope this info is helpful to you.
Post your further queries if any on http://bit.ly/drsureshheijebu
Thank you
Above answer was peer-reviewed by
 
Follow-up: What causes blood clots in urine? 19 hours later
Discontinued Zoladex 2007 due to fatigue; regularly monitor PSA as well as coumadim PT INA…Radiation (external beam ) discontinued 1990 after initial treatments..stayed on zoladex 'till 2007. How about Proton therapy? Is that something to consider? Is it ever wise to resume radiation again after initial treatments?
 
 
Answered by Dr. Suresh Heijebu 1 hour later
Brief Answer:
Proton therapy is an excellent option

Detailed Answer:
Hi sir,
Thanks for writing back,

Its good to monitor through PSA and PT/INR.

Consider using Zoladex in case there is elevated PSA,in consultation with your doctor.

Its not wise to resume Conventional EBRT-external beam radiotherapy i your case as there is a risk of flaring of radiation cystitis.

Intensity modulated proton therapy is an excellent option to be considered in your case as it associated with minimal side effects.

This is a non invasive therapy with out surgery useful in solid tumors.

Thank you
Above answer was peer-reviewed by
 
Follow-up: What causes blood clots in urine? 2 days later
You mentioned injection of sclerosing injections of1% Ethoxyscierol into the bleeding area as well as Hyperbanic oxygen therapy etc..
What kind of doctor would perform these procedures? Do most hospitals have facilities for tis?
 
 
Answered by Dr. Suresh Heijebu 10 hours later
Brief Answer:
TEAM OF DOCTORS

Detailed Answer:
Hi sir,

These treatments are offered by team of doctors involving Urologist,Nephrologist,Surgical and Radiation oncologists.

Yes Tertiary health care centers with equipped sophistication have these facilities.

These are available at The Steeple chase cancer center-Somerset,315 East main ST,NJ.

Thank you
Above answer was peer-reviewed by
 
Follow-up: What causes blood clots in urine? 11 hours later
You mention sclerosing injections. What effect, if any, would these injections have on my bladder (previously cauterized)?
 
 
Answered by Dr. Suresh Heijebu 9 hours later
Brief Answer:
PREVENTION OF FURTHER BLEEDS

Detailed Answer:
Hi Sir,
Sclerosing injections can cause obliterative fibrosis of the lumen of the blood vessels which are liable to bleed following radiation injury.

High risk vessels are identified through cystoscopy and then the sclerosant is injected into the risky blood vessel mass.
This would prevent subsequent bleeding.

This form of therapy can be used in previously cauterized bladder as well.
It has no special side effects.

THANK YOU

Above answer was peer-reviewed by
 
Follow-up: What causes blood clots in urine? 12 hours later
Are the sclerosal injections given under anesthesia?

Have you heard these injections can have a negative effect on the bladder?
 
 
Answered by Dr. Suresh Heijebu 47 minutes later
Brief Answer:
No side effects on bladder.

Detailed Answer:
Hi Sir,

Sclerosing injections are given under local anesthesia.

The injections act by local sclerosing action only,

They do not have any systemic side effects on bladder or else where.

Thank you
Above answer was peer-reviewed by
 
Follow-up: What causes blood clots in urine? 46 hours later
Can you explain the procedure when using sclerosing injections? How is the needle guided into correct area? Do they use a scope while injecting needle?
The local Dr seems reluctant to use injections (probably not experienced); leans toward another cauterization. I would prefer injections (less invasive; local anesthesia). I previously asked you to describe the procedure when using injections. Do they use a scope or some kind of ultrasound, etc..?

I am presently not bleeding , etc & am keeping my fingers crossed. Will make decision on treatment after receiving your comments
 
 
Answered by Dr. Suresh Heijebu 15 hours later
Brief Answer:
Injection sclerotherapy is the procedure of choice

Detailed Answer:
HI, Sir,
Thanks for writing back to me,

Let me frankly tell you that cauterization does not produce long lasting results, as this radiation induced hemorraghic cystitis(post irradiation telangiectatic cystitis-PTC) is a desperate,difficult to manage and exsanguinating condition due to frequent on and off bleeds into urine following rupture of delicate veins (located beneath the bladder mucosa) secondary to increased intravesical pressue(pressure in the bladder) during voiding of urine.

Bladder cauterization cannot prevent this perpetuating mechanisms and is less effective.Multiple sessions are often needed to arrest bleeding with low successful outcome.

Injection sclerotherapy with 1% ethoxysclerol is a meticulous,careful and a watchful endeavor which can detect all possible areas of vesical(bladder) telangiectatias(abnormal weak dilated veins prone for rupture) to cause obliterative sclerosis(permanent destruction) of the culprit blood vessels/veins.

Technique of injection:

The bladder is first evacuated of all the clots if any until the returns of irrigating fluids are clear.

A cystoscope( a type of endoscope) now withdrawn towards the bladder neck to visualize all the areas of blood streaking/telangiectatic areas.

After taking multiple biopsies of the bladder mucosa(an additional advantage with this procedure),these telangiectatic areas are sclerosed with 15 ethoxysclerol using an endoscope needle of size 21Fr.

A combination of intra and perilesional injection is carried out depending on the degree and grade of the lesion.

The sclerosant is injected beneath the telangiectatic vessels which usually occypy an area of less than 5mm.

A total of 20-25ml of sclerosant may be needed to be injected into each telangiectatsia with about 0.5 ml into each.

The bladder irrigation with saline is continued post op for 48hrs and patient is placed on antibiotics for the next 3 months.

Most patents remain free of hematuria with the first session only ,
very few patients with very large telangiectatic areas greater than 5mm with associated complex often require second session.

Most of the patients remained symptom free in their follow ups ranging from 1 to 4 years.

Thank you
Above answer was peer-reviewed by
 
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