Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

173 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

What causes blood clots in urine?

Answered by
Dr.
Dr. Suresh Heijebu

General & Family Physician

Practicing since :2010

Answered : 3551 Questions

default
Posted on Tue, 2 Sep 2014 in Cancer
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.
doctor
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 : Dr. Raju A.T
doctor
default
Follow up: Dr. Suresh Heijebu 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?
doctor
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 : Dr. Prasad
doctor
default
Follow up: Dr. Suresh Heijebu 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?
doctor
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 : Dr. Prasad
doctor
default
Follow up: Dr. Suresh Heijebu 11 hours later
You mention sclerosing injections. What effect, if any, would these injections have on my bladder (previously cauterized)?
doctor
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 : Dr. Bhagyalaxmi Nalaparaju
doctor
default
Follow up: Dr. Suresh Heijebu 12 hours later
Are the sclerosal injections given under anesthesia?

Have you heard these injections can have a negative effect on the bladder?
doctor
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 : Dr. Vinay Bhardwaj
doctor
default
Follow up: Dr. Suresh Heijebu 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
doctor
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 : Dr. Prasad
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Treatment/Therapy
Medical Procedures
Medical Topics ,   ,  

Recent questions on  Local anesthesia

doctor1 MD

I have had pain in my index finger for a month and trouble straightening and bending my finger. There are times that my finger remains in a curled position and is very hard to straighten. Could this be arthritis?

doctor1 MD

I m 58 and had what could be my 1st possible UTI. Well now I m scheduled for a cystoscopy . I ve read the flexible ones are no wider than a pencil and the rigid are bigger. My urethral opening is smaller than a pencil, how are they going to get...

doctor1 MD

Hi .i have very little skin attached to my pennis and i feel pain while having sex, while sexual inter coarse . it also got torn earlier while having anal sex now i feel pain in inserting pennis. How can i remove frenulum or make it elastic at...

doctor1 MD

my wife has fungal infection in both ears. removing the same is causing terrible pain. could you pls suggest whether the fungal infection can be cleared after giving local anesthesia? My other doubt is that whether she need to consult the doctor empty stomach for the above treatment with local anesthesia?

doctor1 MD

My doctor wants to do a skin graft on a wound on the calf of my leg. It is about the size of a quarter. I have a pacemaker for a slow heart rate. He says I have to receive general anesthesia. Can I have a graft done with local anesthesia? I ll be honest, I am very concerned about being put to sleep.

doctor1 MD

My son went to the dentist yesterday to get a cavity filled. They gave a local Anesthesia in his mouth. when he got out the dentist , his started swelling up . I want to know how can we cure this or is it normal for his lip to swell up after anesthesia