Armor Men's Health Show

Does Peyronie's Cause Hematuria? Dr. Mistry and Donna Lee Answer Listener's Question on Blood in the Urine

• Dr. Sandeep Mistry and Donna Lee

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Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Dr. Mistry and Donna Lee answer a listener question about microscopic hematuria. He asks: "Is it normal for microscopic blood to show in your urine when you get older? If the answer is no, could it be caused by Peyronie's disease?" Dr. Mistry explains that while microscopic hematuria, or small amounts of blood in the urine, always warrants investigation by a urologist, it is often benign. Visible blood in the urine, however, is worrisome, and it should be addressed as soon as possible. If you see blood in your urine but aren't experiencing any pain, your chances of receiving a cancer diagnosis are as high as 30%. To answer the listener's second question, hematuria is generally not caused by Peyronie's disease. Peyronie's disease is characterized by the development of a bend in the penis and/or an hourglass deformity. This condition may be caused by the slowly accumulating effects of microtrauma to the penis sustained during intercourse with a less-than-fully-erect penis, or even by severe, acute trauma. Scar tissue can develop along the penis shaft, causing the often painful and distressing changes associated with this incredibly common condition. If you think you may have Peyronie's disease, please see a urologist! And if you see blood in your urine, don't delay in seeking treatment. 

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Phone: (512) 238-0762
Email: Armormenshealth@gmail.com
Website: Armormenshealth.com

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Speaker 1:

Welcome to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry:

Hello and welcome to the Armor Men's Health Hour. I'm Dr. Mistry, your host, here as always with my cohost, partner in crime, professional comedienne, Donna Lee.

Donna Lee:

That's right. I am very funny by the way, as Dr. Donna.

Dr. Mistry:

I have been told that I'm the funny one of the group, by people who really liked me.

Donna Lee:

Well, you are pretty funny and funny looking.

Dr. Mistry:

I'm a board certified urologist. This is the men's health show. We talk about...

Donna Lee:

Everything.

Dr. Mistry:

Everything. We do, we do like to focus on urologic issues, because that's what I know so much about. I have a good friend, someone who's on our, on our show. His name is Joel Hurt.

Donna Lee:

He's going to be on our show again, by the way.

Dr. Mistry:

Yeah, he's, he's awesome. He started his own orthopedic practice. He's a sports medicine doctor.

Donna Lee:

It's a fun name, though. Dr. Hurt.

Dr. Mistry:

Yes. Maybe I only make friends with people who have funny doctor names.

Donna Lee:

I think so.

Dr. Mistry:

Dr. Mystery, Dr. Hurt. He, he, one day, uh, while we were having a meal said just the stuff that we just, as, as urologists or surgeons, just kind of just we'll know, immediately off the top of our head, just, just the very basics are so valuable for patients to hear. And that really was a big impetus for why we started this show. Just this idea that we could share a one hour consultation with our listeners every week. The most time you'll get with a urologist.

Donna Lee:

That's true. I've been asked several times,"Why do you do the show if it really doesn't make a whole ton of money for you?" And I'm like,"Well, actually, it's to educate." We want to educate all the men folks out there. And a lot of the women folks, cause we do a lot of women topics as well.

Dr. Mistry:

Another reason is that when you come to see us, we're not just a regular urology group. You're going to get advice on supplements. You're going to get nutritional advice. If you're diagnosed with prostate cancer with us, you all of a sudden are going to have a team around you. We're going to have a pelvic floor physical therapist, and we have a sex therapist, and we're going to give you supplements, and we're going to change your diet and help you lose weight, not just slice and dice.

Donna Lee:

That's right. And if you ask for me, I'll tell you a joke.

Dr. Mistry:

And you get a shirt!

Donna Lee:

Bonus! Free t-shirt.

Dr. Mistry:

And so, and, and the show really helps prime people to know that when they come to see us, they're going to get something different. And that's important because if you think you're going to a place and going to get, you know, one type of service and they offer you something completely different and you're not prepared, you're going to feel like something's wrong, right? But we want you to know that we're here to take care of you. We love second opinions. So you may have a urologist that you love, or maybe one that you don't, and, and want some advice. But if you've been diagnosed with prostate cancer, or you are headed for surgery for your prostate, or you're having low testosterone issues, and you need a second pair of eyes to look at them, we have, we have amazing eyes here.

Donna Lee:

That's right. But don't come to Dr. Mistry and then go get a second opinion, because that hurts his feelings.

Dr. Mistry:

That is not true. That's not true.

Donna Lee:

I think so.

Dr. Mistry:

They always come back.

Donna Lee:

They do come back.

Dr. Mistry:

They always come back.

Donna Lee:

That's true, too.

Dr. Mistry:

We love your questions. We would love to see you as a patient in our practice. Donna, where are locations and how do they get hold of us?

Donna Lee:

We are all over the place in Central Texas. If you live here are in Round Rock, north Austin, south Austin, and Dripping Springs, Texas, where their logo is,"We love dripping."

Dr. Mistry:

And if you are listening to this as a podcast where you can listen to all podcasts and don't know where anything we're talking about, then we're sorry about that.

Donna Lee:

But we're also able to fix your dripping. Our phone number is(512) 238-0762. Our website is armormenshealth.com and you can send your amazing, insightful, and very helpful questions to armormenshealth@gmail.com.

Dr. Mistry:

Thank you, Donna. Do we have a question?

Donna Lee:

We do. He misspelled your name, like the mystery novel."Dr. Mystery, hello. My name is[bleep]. My question is the last two times my primary doctor ran labs on me. He said it showed microscopic blood in my urine. He has referred me to another urologist. [Bleep.] Is it normal for microscopic blood to show in your urine when you get older? If the answer is no, could it be caused by Peyronie's disease? Please let me know." He's in his sixties.

Dr. Mistry:

I love it, because...

Donna Lee:

I like that he tied in Peyronie's and blood.

Dr. Mistry:

Yes, there's so much, there's so much to unpack there. Having blood in the urine is a very common reason that patients get referred to us as urologists. Blood can enter or touch the urine at many different points as the urine is made. It can be from the kidney and it goes into the ureters, which are the tubes that go from the kidney down to the bladder. That it can be from something it touches in the bladder, and that it can be something on its way out of the bladder where it touches the prostate and the urethra.

Donna Lee:

That's too many touch points.

Dr. Mistry:

There's a lot of touch points. And so what do we care about? I'm trying to rule out cancer. That that's simple. Now, fortunately bladder cancer or a type of cancer that would cause bleeding in the urine is very rare if you can't see it. Once you can see it, if you can see blood and have no pain, then, then the chance of having cancer somewhere along the pathway is almost 30%. So, but fortunately...

Donna Lee:

So don't dilly-dally.

Dr. Mistry:

If you see blood, that, you need to come make an appointment, don't be like,"Oh..."

Donna Lee:

Because it's been there.

Dr. Mistry:

And, and, and especially, you'll be like,"Well, I had blood, but then it went away." Like, that's still dangerous because even, most bladder tumors will bleed once and then stop bleeding. And so, kidney cancer, bladder cancer...Kidney stones are a very common cause of blood in the urine. But I think the most common cause that I see in 60 year old men is going to be early changes of an enlarged prostate. So as the prostate enlarges, it kind of gets very, very leaky blood vessels, can easily bleed into the urethra and into the urine. And fortunately it doesn't need to be fixed. As long as we ruled out bladder cancer or kidney cancer, then nothing needs to be fixed for the microscopic hematuria. That means that you can't see it. It's only on the test that they run when you pee in the cup.

Donna Lee:

Do most PCPs do that?

Dr. Mistry:

Most PCPs do that. We see a lot of people doing their DOT physicals, for like truck drivers. And then we'll see a lot of other types of people that just have routine physicals as part of their work requirements. So police officers, firemen, we'll see a lot of. Generally running a urine is part of your, your physical. We see a lot more microscopic hematuria that ends up being nothing in women. So it men, when we see it, it ends up being associated with something more, more likely. And so...

Donna Lee:

Why is it nothing in women?

Dr. Mistry:

I think that as women age and they get into menopause, then there are changes in the vagina that occur that make it more prone for blood in the urine, and those kinds of changes usually aren't, sometimes they're not symptomatic. Sometimes they are, but, but most times, they're not. And so in a man, both for men and women, the way we work up microscopic hematuria is we order a CAT scan, and that's going to be a radiographic evaluation of the abdomen and pelvis. You will get a contrast, an iodinated contrast. The whole thing only takes about two minutes, really, to scan you. But we're able to look at the kidneys. We're able to look at the internal lining of the ureters and the inside of the kidney, and somewhat look at the bladder.

Donna Lee:

And why is contrast important? Cause we always get patients who're like,"I don't want contrast!"

Dr. Mistry:

Because if you take the picture without any color, contrast gives you color.

Donna Lee:

Okay.

Dr. Mistry:

So if you don't take the contrast and everything's ends up being the same shade of gray and you cannot tell the difference between cancer and non-cancer.

Donna Lee:

Hm. That's important.

Dr. Mistry:

And so that's, that's the whole reason you're doing the test in the first place. If you don't want contrast that's injected into your vein, then we have an alternative. We can get an ultrasound and then take you to the operating room and inject it up the ureters. And that's what we used to do when we were residents. That's what we did. We had like a whole clinic full of people that we did it while they were awake, too. I'm telling you, wow, we did some things when you're training. It's because, you know, if you need to do 10 of them, it was just so much quicker just to just get them all 10 banged out. If you do in the OR, you can only do maybe three or four in a day. So, that's the, that's the reason why we did it like we did. We also look in the bladder with a camera. We talk about all the time, looking in the bladder with a small scope.

Donna Lee:

The little cystoscopy.

Dr. Mistry:

The cystoscopy scope. We do probably, you know, our clinic wide, we probably do about 30 to 40 a week, these cystoscopies, looking into the urethra, looking around the bladder for tumors, taking samples of fluid if we need to. And that's how we approach the evaluation for microscopic hematuria. And if you've had it on multiple occasions as this listener saying, because clearly what happened was he had it last year, and then didn't go to the doctor, and they saw it again. And the doctor's like,"You need to go see a urologist." And the answer is yes. As part of his overall workup, making sure that he has an accurate PSA, and the CT scan and cystoscopy would be how we handle it. And then, you know, if you, if we think it's coming from your prostate, but you're not having any symptoms, we just ignore the whole thing.

Donna Lee:

So watchful waiting?

Dr. Mistry:

Active surveillance, for those of you that listen. The second part of his question was whether it could be due to Peyronie's disease. The short answer is no. A curvature of the penis is unlikely to cause blood in the urine. But Peyronie's disease, it, it affects, I, I'm convinced it affects a lot more men than the studies would suggest, right? Because I would say almost 20% to 30% of the questions that we get on the show or about the bent penis problem with Peyronie's disease. And I think it's because it's not life-threatening, and so, and it's an embarrassing to talk about, so it's probably has a higher prevalence. But for those of you that don't know about it, an abnormal curvature of the penis or an hourglassing deformity that causes the penis not to look right when erect. Very common, we treat it as urologists. We can treat it with medication. We can treat it with surgery. We can treat it with injections. But we can't treat it if you don't come and tell us about it. So...

Donna Lee:

And please, dear Lord, start with a urologist and not one of those little weird pop-up clinics that claim, they guarantee to fix everything.

Dr. Mistry:

Yeah. Do not shockwave your Peyronie's. You know what I'm saying? It's not going to, it's not, you, you think it's going to help. They're going to tell you it's going to help. It's not going to help.

Donna Lee:

Right. And you pay them$5,000.

Dr. Mistry:

And like I say, all the time, if you're, if you have a problem with your pee-pee, go to a pee-pee doctor, not someone who sells shockwave, you know what I'm saying? And that's, I mean, I have to deal with the insults and the jokes all the time. I might as well get the patients, too, right? I am your pee-pee doctor. Donna, how do they make their appointment with their pee-pee doctor?

Donna Lee:

For that guy who's going to call and complain about how juvenile juvenile we are, you can just stuff it, sir. It's 512-238-0762. Our website is armormenshealth.com. And our email address as everybody knows the song, it's famous now: armormenshealth@gmail.com.

Dr. Mistry:

And if he needs help stuffing it, you can give us a call back, too.

Speaker 1:

The Armor Men's Health Hour is brought to you by Urology Specialists. For questions, or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.