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I recently had a well man check up & i was told i had

Customer Question
I recently had a...

I recently had a well man check up & i was told i had microscopic traces of blood in my urine,which i can't see with the naked eye..i was then told i have no urinary infection when my results came back..i have also been told i have a raised PSA level which i am about to have a blood test for..i wondered if there are serious signs here.i am 55 and told that a enlarged prostate is common in men my age..i also sometimes get a dull ache in my scrotum and i had this checked about 2 years ago but was told it wasn't anything serious..what do you think is causing the blood in my urine and other symptoms i've mentioned?

Doctor's Assistant: Is this a time sensitive issue? What type of specimen are they testing?

Testing for cause of raised psa and cause of microscopic blood in urine..all this came to light at my wellman check up..so i have no idea how long it's been occuring.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Not really that i can think of.I'm anaemic (mildly) & i suffer from acid reflux which i've been taking Lansoprazole tablets for approx 4 years now..i also take an antihistamine tablet each day.

Submitted: 2 months ago.Category: Urology
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Answered in 37 minutes by:
5/28/2018
Urologist: Dr. S, Board Certified in Family Medicine replied 2 months ago
Dr. S
Dr. S, Board Certified in Family Medicine
Category: Urology
Satisfied Customers: 49
Experience: Attending physician
Verified

Hello, I am Dr. S and look forward to working with you towards an answer to your question.

There are multiple causes for microscopic hematuria, some of which you have all ready addressed.

A urinary tract infection can cause blood to appear in the urine, however if they did a culture and it was normal, there is not an infection causing it.

One thing to ask your doctor is if a full urinalysis was done with microscopic evaluation. This will be able to tell if there are whole blood cells present that are causing the test to be positive or if it is fragments or other similar chemicals that are causing it to be positive. An example is someone with liver issues will sometimes show blood on a urinalysis, however it is not actual blood. If you had a full check up, they likely checked your liver and kidney levels with the bloodwork.

Other causes can be related to exercise and muscle breakdown or being dehydrated. Exercise done before the urine test can sometimes show a false positive for blood. Being dehydrated also makes the urine more concentrated and will sometimes show a positive result. Making sure to drink plenty of fluid before a urinalysis is important.

Some people will also have microscopic blood just because, there is nothing medically wrong with them, it is just there.

What they want to make sure is that it is not something bad going on.

The bad things that they want to rule out:

1) Prostate cancer. This can be related to an elevated PSA, however an elevated PSA and blood in the urine is not always prostate cancer. The additional testing you are having is likely looking for prostate cancer. A swollen prostate or BPH is common in men as they get older and if enough of the benign swelling is there, it can cause inflammation which again can cause the urine to show microscopic blood.

2) A mass in the bladder. The bladder is the storage pouch and if there is inflammation or a mass in the bladder, this can bleed and cause the urine to appear positive. Usually it will be noticeable by the eye in the urine when it is bad. To test for this, an ultrasound (What pregnant women have to look at babies) or cystoscopy (inserting a camera into the penis to directly visual the bladder, like a colonoscopy, but smaller camera) are typically done.

3) A mass in the ureter (tube leading from kidney to bladder) or kidney. This can be a cancer mass or a benign lesion like a cyst that can bleed. If the mass or cyst is connected to the area collecting urine, then it can also cause the urine to show blood. To check for this, usually an ultrasound or CT/CAT scan is done to visualize the area.

4) Infections of the testicles or semen delivery system. The doctor can usually determine on physical exam if there is a tender area of concern. Testicles are typically evaluated by an ultrasound if needed. If you have any risk for sexually transmitted diseases, then to be tested and treated if needed is a good idea.

-The big thing when dealing with hematuria (blood in the urine) is to rule out the bad. It appears you are all ready starting this workup which is good. Many times, this workup will come back normal, which is good. To rule out the bad. If that is the case, then it is usually either idiopathic (we don't know what causes it, but it is not one of the bad things) or the above dehydration issue.

-I understand that this is very concerning, but it appears you are on the right path for the workup. Most of these are benign, however if they do find something, catching it early tends to result in better outcomes.

-If you have additional questions or would like clarification on any of the above, please message back.

-If you feel the above has provided good information, please leave a positive 5 star rating so that I may continue to answer questions for others. This will not close the message, so you may still respond back after rating if you have further queries. Thank you.

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