Hello and welcome to Medical Fun Facts episode 83, something beginning with H
It's Monday 11 September 2017
Thank you for listening and thank you for watching Medical Fun Facts a short show with a few medical facts and hopefully one or two funny lines.
Don't expect too much from each episode and we'll all be happy.
Last week I mentioned my thoughts about using a search engine like Google as a diagnostic aid.
This week I want to talk about hæmaturia or blood in your urine.
The most common causes include:
- A urinary tract infection
- Kidney stones anywhere from the renal pelvis or in the bladder or in the ureter
- Carcinoma or a malignancy of the kidney, bladder or prostate in men
- Benign prostatic hypertrophy in older men
- Having an indwelling catheter
- Vigorous exercise
- A less common but noteworthy cause is sounding or deliberate instrumentation of the urethra for nonmedical reasons
There are also other less common causes too.
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Urinary tract infection
Urinary tract infections are a relatively common event, especially in young women. Infections caused by bacteria cause inflammation of the mucosal lining of the ureter, bladder and urethra which can lead to the leakage of blood from capillaries. Visible blood in the urine is a good reason to have your urine examined microscopically to check for not only infection but for other abnormalities. It's also important that urine is not examined by microscopy and culture unless there are symptoms present or unless the patient is pregnant or younger than 16 or has recently had instrumentation of the urethra. The reason I say this is because far too many urine specimens are collected and patients referred for microscopy and culture for no real benefit. It's a waste of valuable tax dollars that could be spent elsewhere in the health system.
Kidney stones are awful. I'm fortunate that I'm yet to experience what is known as renal colic which is when a stone or calculus is stuck in a ureter and smooth muscle walls of the ureter squeeze down and you get a blockage. The pain can be very intense and comes in waves. You can get a set of intense pain and then it lulls for a while and then it hits. You experience intense pain, you sweat, you buckle up and end up on the floor crying in pain. Kidney stones are really bad news.
A punch in the back around where the kidneys are can cause trauma. A decent enough punch will cause the kidney to bleed and there will be blood in the urine. Did you know that people who receive a kidney or renal transplant have the donated kidney placed in the lower abdomen in the pelvis? If you've received a kidney transplant you don't want to get into a fight and get punched in the lower belly.
A neoplastic disease like renal cell carcinoma, transitional cell carcinoma of the urinary bladder and other malignancies affecting the urological system can cause blood in the urine. So if you have persistent blood in the urine and infection and other causes have been excluded, urine examination by a cytopathology scientist or a cytopathologist is warranted.
Benign prostate disease
As a man in my fifties, every time I feel like passing urine I wonder if my prostate is getting bigger. Prostatic disease needs to be considered in men over the age of 50. Does this mean that men over 50 should seek a blood test with prostatic specific antigen? Not necessarily. This is a very contentious area and may be something I can discuss in a later episode.
If you have a catheter in your urethra with a bulb in your bladder, it's not uncommon for there to be some friction and rubbing of the delicate mucosal lining of the urethra and bladder. This can lead to blood in the urine. The other thing an indwelling catheter can cause is bacteriuria which is bacteria in the urine. Anyone with an indwelling catheter will within a week have bacteria in their urine. Such a situation though does not mean the person needs antibiotics because the bacteria are colonising the catheter and not causing infection. They may go on to cause infection, but in the main, IDC associated bacteriuria does not require antimicrobial treatment unless the patient has symptoms consistent with a urinary tract infection. The best move is to remove the IDC if possible. If an IDC is required, changing IDCs may be required.
Now some men find self-stimulation of the urethra with a metal sound to be enjoyable. This is effectively self-instrumentation, and depending on the metal sound [the link takes you to my favourite NSFW podcast] and the technique of insertion some trauma of the mucosal lining of the urethra can occur. If the trauma is significant, you may see blood at the end of your penis. I remember when I was an intern an older man with a significant prostatic disease who thought the problem he had was in his penis so he took a lead pencil, removed the lead and inserted the hollow wooden pencil into his penis and went too far. He wasn't familiar with the anatomy of his urethra and so when there was a change in direction the sharp tip of the wooden pencil breached his urethra and this lead to significant bleeding and pain.
So, some questions for listeners.
- Have you ever had unexplained blood in your urine?
- Have you ever put anything in your urethra? If you have, why?
Please leave your answers in the comments section of the show notes or on the Facebook page or on YouTube.
That's episode 83 in the can.
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If you have any questions or comments please let me know. If I've said anything incorrect I welcome correction. I'll catch you next week for episode 84. Something beginning with the letter I. Send me suggestions.
Thank you, and good night.