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Urinary Disorders

Medical mystery

08/07/2008

Question:

I`m a 53-year-old perimenopausal female. About nine days ago I experienced what felt like the beginning of a UTI. I drank lots and lots of water and began to feel better. Two days later I felt most of the classic signs (feeling of pressure in the bladder, urgency, frequency) of UTI and had a significant amount of blood in the urine. Bleeding was also present between voidings, appearing as very red on the toilet tissue and as staining on a sanitary pad. I assumed I had gotten my period, but when the UTI symptoms persisted, I called my GYN. She prescribed the generic equivalent of Bactrim DS. After a single dose, I began to feel better and the hematuria began to resolve. I still don`t know if any of the bleeding was menstrual. Here`s the medical mystery part: the pre-antibiotic urine sample I collected (with gross hematuria) showed no evidence of infection after being cultured. The urine sample I collected today (after 6 days on the antibiotic) was infection-free on the dipstick and showed no evidence of microscopic hematuria, according to my doctor`s office.

If I didn`t have an infection, why did my symptoms and the hematuria begin to resolve almost immediately after starting the antibiotic? Can hematuria connected to other disorders respond to an antibiotic? Except for some intermittent residual bladder discomfort between voidings (usually resolved by drinking lots of water), I feel back to normal. How should I proceed? Thank you for your help.

Answer:

In general, hematuria not explained by culture-documented infection or presence of kidney stone should be evaluated to rule out other causes. The current standard of evaluation is an upper tract imaging procedure (we use CT urogram rather than IVP- more information, same time) and cystoscopy which is performed in the office unless there is abnormality on the CT urogram which mandates further upper tract infection. Causes of blood in the urine include stones, infection, trauma, tumor, and bleeding disorders. Our priority is to rule out tumor which may require treatment- early diagnosis and treatment is preferred since many may be cured with minimally invasive techniques.

The voiding symptoms increase the suspicion of urinary rather than gynecologic causes. The bleeding between voids confuses the issue, and a pelvic exam may be helpful in making the distinction. The CT urogram can help with respect to uterine abnormalities such as fibroid tumors (benign). You should review with a urologist.

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati