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I today noted several bright red drops of blood in my urine

 
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I today noted several bright red drops of blood in my urine (at the end of the flow). Urinating was no more uncomfortable than usual, though I now feel substantial groin fullness and (possibly referred?) pain at the tip of the penis. If the blood originated in the prostate, would it possible occur at the end of the flow? Could kidney problems cause this? What diagnostic tests would be reasonable?

 

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Person's Gender: Male
Person's Age: 57

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I should note that I had a few drops of blood at the beginning (I think) of the flow a couple of years ago, with buring on urination. It was suspected that it was prostatic in origin, but a cystoscopy was recommended, but never done. This time it is more bright red drops of urine (rather than a single "plug" of blood), and is at the end of my flow. What are the most likely causes of this blood? Thanks so much.

Submitted: 365 days and 4 hours ago.
Category: Urology
Value: $43
Status: CLOSED
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Expert:  Dr. R replied 365 days and 4 hours ago.


Dr. R : Hello and thanks for your question. Please be patient as I respond: I may be in the OR or seeing a patient and will respond ASAP.
Dr. R : Blood in the urine can be caused by infections, inflammation, stones or growths anywhere in the urethra, bladder or kidneys. This must be evaluated by a urologist to rule out a growth as the source. The evaluation includes a urinalysis, a urine culture, a urine cell test called a cytology, as well as a Ct scan of the kidneys ( or a sonogram) and a cystoscopy, where the urologist looks in the bladder. Most likely not cancerous, but the evaluation needs to be done to be sure. 
Customer :

Does the presence of blood at the end of the flow tend to indicate a particular source (i.e. bladder vs. prostate vs. kidneys)? Also, does my extensive history of prostatitis and BPH, and a prostate at times described as "boggy" on exam make the prostate (inflammation or irritation) a more likely origin? Also, just to note, this occurred within 16 hours of two ejaculations that were the first in two weeks. Thanks.

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Expert:  Dr. R replied 365 days and 4 hours ago.

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Customer replied 365 days and 4 hours ago.

Does the presence of blood at the end, vs. beginning, or middle, of the flow tend to indicate a particular source (i.e. bladder vs. prostate vs. kidneys)?Also, does my extensive history of prostatitis and BPH (which makes voiding sometimes very effortful), and a prostate at times described as "boggy" on exam, make the prostate (inflammation or irritation) a more likely origin? Also, just to note, this occurred within 16 hours of two ejaculations that were the first in two weeks. Thanks so much.

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Expert:  Dr. R replied 365 days and 3 hours ago.

Yes, blood at the beginning tends to be urethral or prostatic versus middle or end which tends to be bladder- but that is just a best guess. Your history of BPH and prostatitis means it is more likely to be prostatic, but you still need a full evaluation.

Expert TypeBoard Certified Urologist
Category: Urology
Pos. Feedback: 98.5 %
Accepts: 3512
Answered: 4/10/2012

Experience: Authored over 25 Book Chapters and Articles, Specializes in male and female voiding issues

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Customer replied 365 days and 2 hours ago.

Thanks so much for your prompt and cogent response. As I don't currently have a urologist - might you by any chance know of a urologist somewhere in the Mass General, Brigham and Womens, Beth Israel/Deaconness medical world of the Boston area, that you might recommend as a nice person and skilled clinician, since Columbia is a bit of a hike for me from Boston:)? Thanks so much again for all your help.

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Expert:  Dr. R replied 365 days and 2 hours ago.

Mark Katz at BU is outstanding.

Customer replied 365 days and 2 hours ago.

Thanks so much for all your kind, prompt, and helpful responses, and for the reccomendation of Dr. Katz. I look forward to seeing him. (Well, at least to the extent I am able to look forward to seeing anyone wielding a cystoscope!). Thanks again.

 
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