Thursday, June 20, 2013
Hematuria - Should I Get 2nd Opinion
I had flank pain in October. A urine test indicated microscopic blood in my urine. My PCP had me tested for kidney stones, twice, a month apart. CT scans were done without contrast. No stones. I still have blood in my urine. I saw a urologist in April and still hve blood. I had a cystoscopy and the bladder was fine, clear fluid was observe coming out of my ureters. The doctor told me he saw reactive cells in my last urine sample. He said it was not a big deal. What are reactive cells and should I get a second opinion? I have other symptoms like frequency at night time. I am 36 and have had at least 12 UTI`s since I was 18. (I`ve only had one sexual partner my entire life.) My PCP told me I should urinate immediately after intercourse since I`m prone to UTI`s and I do, religiously. My urologist did order another CT with contrast.
My standard evaluation plan for either hematuria or recurrent UTI is a CT urogram which is different from a CT without contrast (because it's done with and without contrast) and different from the routine CT scan done with and without contrast (because there is a delayed CT scan which allows the ureters to be visualized for any filling defects or other anatomic abnormalities that might otherwise not be identified). Then a cystoscopy is performed (because the CT urogram does not identify some subtle changes in the bladder).
In the case of recurrent UTI, if the patient can clearly link the occurrence to sexual intercourse, prophylactic antibiotics can be taken after intercourse to ward off infection. If not linked to sexual intercourse, and all findings are normal on the CT urogram and the cystoscopy, I provide patients with antibiotic prescription which can be used for one year as needed (symptoms that are related to infection). If resistance to that antibiotic (for instance, Macrodantin) arises, then culture and sensitivities must be done after antibiotic is discontinued. In general, this spares the patient visits to office or urgent care to get prescription.
This is all predicated upon the patient having had confirmed (with culture and sensitivity) recurrent UTI. Some physicians treat based upon urinalysis alone and that is not sufficient. Hope this is helpful.
James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati