I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

Sudden blood in urine, 4 weeks after prostatectomy

Email this conversation Print this conversation
User
Posted 16 Mar 2016 at 21:14

I'm nearly 4 weeks post robot assisted prostatectomy.

This morning, woken by the early morning desire to urinate, I was shocked to notice that the urine had gone from  normal colour to what looked like tea that's been left overnight on the pot. I understood that the colour was partly due to dehydration after not drinking enough after a  brisk 10 mile walk the day before. But it was much darker than it had ever been before. I guess I thought that restricting my fluid intake before bed, so as to 'sleep' another night pad free,  took precedence over hydration. When I peed for a second time a short while later, the blood in the urine was fresh, the clots small. 

Blood had not been visible in the urine at all since the catheter out 2 weeks earlier, so this came as a bit of a shock. I searched here on the forum for similar experiences. Chris J gave a good description of the panicky feeling that it brought on. I gave the mugs of tea a miss today, switching to pints of dilute orange squash to sluice the bladder out, which seemed to be working by mid afternoon- just a small amount  fresh blood dripping into the clear urine as I finished.  Now this evening the blood is more apparent. most at the start and cessation of urination. It's not as bad as it was when peeing the second time today 

I might have strained the anastomosis  after the walk, in the evening, shortly before bed, when I strained a bit more than usual to deal with a constipated motion. A little bit tired, and with the bathroom cold, my usual care to avoid straining on the loo was not to the fore.

Today, I got in touch with the Uro-oncology nurse 80 miles away who said 'phone me tomorrow, even if it's better. No clarification. So, I'll 'phone her tomorrow. In the meantime,  has anyone else here experienced something similar, and if so - did it just clear spontaneously? I'm guessing that It's just a game of wait and see. If this happened to you , how long did it take to clear? 

I understand that it's an emergency if I have a blockage from large clots- there haven't been any and the flow is OK ( maybe I'm trying not to close off so tightly at the end of urination as this seems to make things more bloody- I suppose it could be the urethra merely squeezing out the blood that is already there rather than the pelvic floor muscles actually causing trauma and blood- I don't know). I'm after  hearing someone who will share their experience. My mind has started to go into anxiety mode- 'will I be recatheterised/ need investigative surgery' etc. I'm not sleeping well so I guess logical thought isn't my strong point at the mo'..

User
Posted 16 Mar 2016 at 21:14

I'm nearly 4 weeks post robot assisted prostatectomy.

This morning, woken by the early morning desire to urinate, I was shocked to notice that the urine had gone from  normal colour to what looked like tea that's been left overnight on the pot. I understood that the colour was partly due to dehydration after not drinking enough after a  brisk 10 mile walk the day before. But it was much darker than it had ever been before. I guess I thought that restricting my fluid intake before bed, so as to 'sleep' another night pad free,  took precedence over hydration. When I peed for a second time a short while later, the blood in the urine was fresh, the clots small. 

Blood had not been visible in the urine at all since the catheter out 2 weeks earlier, so this came as a bit of a shock. I searched here on the forum for similar experiences. Chris J gave a good description of the panicky feeling that it brought on. I gave the mugs of tea a miss today, switching to pints of dilute orange squash to sluice the bladder out, which seemed to be working by mid afternoon- just a small amount  fresh blood dripping into the clear urine as I finished.  Now this evening the blood is more apparent. most at the start and cessation of urination. It's not as bad as it was when peeing the second time today 

I might have strained the anastomosis  after the walk, in the evening, shortly before bed, when I strained a bit more than usual to deal with a constipated motion. A little bit tired, and with the bathroom cold, my usual care to avoid straining on the loo was not to the fore.

Today, I got in touch with the Uro-oncology nurse 80 miles away who said 'phone me tomorrow, even if it's better. No clarification. So, I'll 'phone her tomorrow. In the meantime,  has anyone else here experienced something similar, and if so - did it just clear spontaneously? I'm guessing that It's just a game of wait and see. If this happened to you , how long did it take to clear? 

I understand that it's an emergency if I have a blockage from large clots- there haven't been any and the flow is OK ( maybe I'm trying not to close off so tightly at the end of urination as this seems to make things more bloody- I suppose it could be the urethra merely squeezing out the blood that is already there rather than the pelvic floor muscles actually causing trauma and blood- I don't know). I'm after  hearing someone who will share their experience. My mind has started to go into anxiety mode- 'will I be recatheterised/ need investigative surgery' etc. I'm not sleeping well so I guess logical thought isn't my strong point at the mo'..

User
Posted 17 Mar 2016 at 10:40

I was back at work four weeks post op but took things easy, my job was not manual but did involve a lot of driving and visiting construction sites, recovery is not a race. Keep mobile but no marathons. I have been incontinent twice, I still drink caffeinated coffee late at night before going to bed and found it has little effect on night time visits, I still go 7 -8 hours through the night.

I am now 23 months post, I do recall a small amount of the blood dripping either pre or post urination and I also had small amounts of debris and scab like material. Blood in urine nearly always looks worse than it is, I have experienced having pure blood and fresh clots coming from my penis following an operation and it is quite different from the pre and post urination blood.

I would list “not straining” as my number one tip for recovery. I would be concerned If you have strained the anastomosis, your surgeon would have possibly spent an hour stitching that up and then testing that it was water tight. I am told urine leaking through the anastomosis is one cause scar tissue build-up, that can then lead to a stricture.

This will not do your anxiety any good and it quite rare but it is worth being aware of it. Unless things have changed in the last two years, when you had your Da Vinci op during the operation Hem-o-Lok clips were used to seal off cut blood vessels etc. These clips are left in as a matter of routine and you probably have between 6 and 12 still floating around your pelvic area, 1 in 500 patients have clip migration where the clip migrates into the bladder or through the anastomosis, I had two separate migrations 12 months apart. You might want to look at my profile but as I say it is rare. Typical symptom of clip migration is a reoccurring water infection.

I did not suffer from blockages caused by clots etc. but did develop a stricture which can be caused by several things.

Good that you have contacted your urology department, they are the professionals.

Thanks Chris

User
Posted 17 Mar 2016 at 01:00

Most likely explanation is that these symptoms are as a result of clots being loosened as you heal, probably exacerbated by trying to hike 10 miles so soon after surgery.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 17 Mar 2016 at 07:32

It does sound like you have overdone things and shifted some scabs. I had 2 or 3 huge red weeks after totally straining my newly fixed bladder , but luckily it cleared overnight. Too much too soon from one impatient patient to another. Plenty of time for walking and exercising. It's over-rated anyway. You're only born with so many heartbeats ha :-)). ( I'm joking all you runners out there ).
Hope it comes good soon
Chris

User
Posted 17 Mar 2016 at 11:13

Hi Walnut,

I can't give you any technical explanations I'm afraid.....

Fortunately I never had any blood showing on urination after my op.

I did have some in my catheter a few days post op, but that was it....

Hope you get can get some professional reassurance about this.

My ( uneducated ) guess is that a 'brisk 10 mile walk'  at 4 weeks post op will be the root cause of your problem..

Regards

Luther

User
Posted 17 Mar 2016 at 23:11

Thanks for all the replies. I wrote a reply earlier today which failed to send when I tried. I suspect that maybe I took too long composing it and the computer gave up! My thinking patterns post op seem to be able to put a sentence together. By a paragraph I'm just making sense to myself, then suddenly the mental energy plummets off the edge of a cliff. Normally I'd just have a rest and get back to it, but I usually feel like I can't be bothered to restart the topic-zero motivation.
Strangely I can get my act together and begin a fresh topic. I've noticed the same thing when talking. It's as If I feel I've explained myself and can't be arsed to repeat....My tendency has always been to overanalyse things so I usually crash mentally before physically.

Anyhow, the bleeding is less today - strict rest, additional fluids ( non alcoholic) and added lactulose.
I went over the events leading up to the bloody urine- there's the brisk walk. Maybe overdoing it a bit- guilty as charged. However, since getting rid of the catheter, I'd already had 4 or 5 walks of 5 miles on the flattish and a walk over a 3000' mountain of about 6 miles. In fact I walked up another 3000 footer the day before the 10 miler on mixed terrain, and that was in a howling gale, so the 10 miler was less demanding - apart from the finishing mile when I spotted someone in the far distance and almost race walked to catch him up. Silly me, but I felt glad to be alive and capable.Old habits die hard- 4 years ago, almost to the day, I started a solo unsupported 2000 mile walk with 500, 000 foot of ascent so, although I don't run, I can churn out the miles. Perhaps I'm just trying to emulate Gunwharfman in my rehab! Whatever, there was no blood after the 10 miles.
Whilst on the subject of exercise Chris J, and 'you've only so may heartbeats' let me tell you that I used up quite a few of those heartbeats when I saw the blood the next morning- and that was without the exercise!
There was no blood after I let down my guard by straining ( yes ColwickChris- I thought I was being strict about this until I overdid it- (by the way, is 'colwick' the Herefordshire one? I love the architecture of that area)) at the toilet later that evening either. Maybe I was too tired to consider my actions properly. But the silliest thing I did was to take 400mg ibuprofen for managing chronic hip pain WHILST STILL ON CLEXANE!! Again, not thinking, perhaps blase because it was a supermarket painkiller. I believe that all -walk/strain/medication mix combined to create the bleed.
Because of this, I didn't inject clexane last night ( reasoning that it would help with useful clotting at the anastomosis, and because it would have been the penultimate injection anyway so I was probably OK from a DVT angle). I'm still here, and the bleeding is easing. The Consultant today advised I just keep on with todays course of action. Panic over!

User
Posted 20 Mar 2016 at 12:35
W

When doing a long post select and copy the text before hitting post, if it hangs you can start again and paste the text into the new post.

I had a bladder pressure test a few weeks ago which involved putting a pipe into my bladder, in the following few days the continence improved dramatically. If you look at the mechanics of your replumbed pipes logic would say some debris in the sphincter would make you leak like a sieve. In the past 24 hours I have been totally dry, let's hope it lasts. I have not done a PFE since mid Jan,not suggesting you give up on them and bear in mind this second bout of incontinence is not a direct result of the RARP.

I assume your question on strain was to the other Chris.

Thanks Chris

User
Posted 20 Mar 2016 at 13:23

Thanks for the advice re; long posts.

I'm pinning my hopes for recovery of continence on the notion of  the lining of the pipe being altered by mechanical strain My thinking is that this has led to bleeding and inflammation, which has altered the sealing properties of the bore of the urethra. A bit like your 'debris' mechanism. I'll rest and see if the reduced bleed is accompanied by improved continence. I did find a pukka article on the where the author commented on the importance of the sponginess of the walls of the urethra as important for sealing to create continence.

It sounds a bit like practical mechanics.  I get the feeling you have that analytical /practical mindset.  I had the image of you being into classic bikes when you mentioned debris in pipes. Think I'm getting my impressions mixed up- just remembered it's Kevan of this parish who rides an old (1950's) motorbike in his avatar.

Yes the 'Strain' part of my posting was aimed to Chris J, and since dealt with by PM.

User
Posted 28 Sep 2018 at 16:33

That is a VERY interesting comment. I was reduced to a quivering heap when the catheter was removed. The pain was very bad - I had catheters removed before (after hip surgery) with no pain at all. I will discuss with surgeon when I see him in 10 days time.

Show Most Thanked Posts
User
Posted 17 Mar 2016 at 01:00

Most likely explanation is that these symptoms are as a result of clots being loosened as you heal, probably exacerbated by trying to hike 10 miles so soon after surgery.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 17 Mar 2016 at 07:32

It does sound like you have overdone things and shifted some scabs. I had 2 or 3 huge red weeks after totally straining my newly fixed bladder , but luckily it cleared overnight. Too much too soon from one impatient patient to another. Plenty of time for walking and exercising. It's over-rated anyway. You're only born with so many heartbeats ha :-)). ( I'm joking all you runners out there ).
Hope it comes good soon
Chris

User
Posted 17 Mar 2016 at 10:40

I was back at work four weeks post op but took things easy, my job was not manual but did involve a lot of driving and visiting construction sites, recovery is not a race. Keep mobile but no marathons. I have been incontinent twice, I still drink caffeinated coffee late at night before going to bed and found it has little effect on night time visits, I still go 7 -8 hours through the night.

I am now 23 months post, I do recall a small amount of the blood dripping either pre or post urination and I also had small amounts of debris and scab like material. Blood in urine nearly always looks worse than it is, I have experienced having pure blood and fresh clots coming from my penis following an operation and it is quite different from the pre and post urination blood.

I would list “not straining” as my number one tip for recovery. I would be concerned If you have strained the anastomosis, your surgeon would have possibly spent an hour stitching that up and then testing that it was water tight. I am told urine leaking through the anastomosis is one cause scar tissue build-up, that can then lead to a stricture.

This will not do your anxiety any good and it quite rare but it is worth being aware of it. Unless things have changed in the last two years, when you had your Da Vinci op during the operation Hem-o-Lok clips were used to seal off cut blood vessels etc. These clips are left in as a matter of routine and you probably have between 6 and 12 still floating around your pelvic area, 1 in 500 patients have clip migration where the clip migrates into the bladder or through the anastomosis, I had two separate migrations 12 months apart. You might want to look at my profile but as I say it is rare. Typical symptom of clip migration is a reoccurring water infection.

I did not suffer from blockages caused by clots etc. but did develop a stricture which can be caused by several things.

Good that you have contacted your urology department, they are the professionals.

Thanks Chris

User
Posted 17 Mar 2016 at 11:13

Hi Walnut,

I can't give you any technical explanations I'm afraid.....

Fortunately I never had any blood showing on urination after my op.

I did have some in my catheter a few days post op, but that was it....

Hope you get can get some professional reassurance about this.

My ( uneducated ) guess is that a 'brisk 10 mile walk'  at 4 weeks post op will be the root cause of your problem..

Regards

Luther

User
Posted 17 Mar 2016 at 23:11

Thanks for all the replies. I wrote a reply earlier today which failed to send when I tried. I suspect that maybe I took too long composing it and the computer gave up! My thinking patterns post op seem to be able to put a sentence together. By a paragraph I'm just making sense to myself, then suddenly the mental energy plummets off the edge of a cliff. Normally I'd just have a rest and get back to it, but I usually feel like I can't be bothered to restart the topic-zero motivation.
Strangely I can get my act together and begin a fresh topic. I've noticed the same thing when talking. It's as If I feel I've explained myself and can't be arsed to repeat....My tendency has always been to overanalyse things so I usually crash mentally before physically.

Anyhow, the bleeding is less today - strict rest, additional fluids ( non alcoholic) and added lactulose.
I went over the events leading up to the bloody urine- there's the brisk walk. Maybe overdoing it a bit- guilty as charged. However, since getting rid of the catheter, I'd already had 4 or 5 walks of 5 miles on the flattish and a walk over a 3000' mountain of about 6 miles. In fact I walked up another 3000 footer the day before the 10 miler on mixed terrain, and that was in a howling gale, so the 10 miler was less demanding - apart from the finishing mile when I spotted someone in the far distance and almost race walked to catch him up. Silly me, but I felt glad to be alive and capable.Old habits die hard- 4 years ago, almost to the day, I started a solo unsupported 2000 mile walk with 500, 000 foot of ascent so, although I don't run, I can churn out the miles. Perhaps I'm just trying to emulate Gunwharfman in my rehab! Whatever, there was no blood after the 10 miles.
Whilst on the subject of exercise Chris J, and 'you've only so may heartbeats' let me tell you that I used up quite a few of those heartbeats when I saw the blood the next morning- and that was without the exercise!
There was no blood after I let down my guard by straining ( yes ColwickChris- I thought I was being strict about this until I overdid it- (by the way, is 'colwick' the Herefordshire one? I love the architecture of that area)) at the toilet later that evening either. Maybe I was too tired to consider my actions properly. But the silliest thing I did was to take 400mg ibuprofen for managing chronic hip pain WHILST STILL ON CLEXANE!! Again, not thinking, perhaps blase because it was a supermarket painkiller. I believe that all -walk/strain/medication mix combined to create the bleed.
Because of this, I didn't inject clexane last night ( reasoning that it would help with useful clotting at the anastomosis, and because it would have been the penultimate injection anyway so I was probably OK from a DVT angle). I'm still here, and the bleeding is easing. The Consultant today advised I just keep on with todays course of action. Panic over!

User
Posted 19 Mar 2016 at 10:53

Morning Chris- hope you're having an easy day.

Do you mind me asking,  as you mentioned in your journal that, although you had good initial continence post op, you had worsening incontinence after your overstrain- how long did it take to recover your continence after that event?

I can't find any reference to this happening apart from your experience.  The day of rest following my bleed was not markedly worse continence wise, but the day following that it was like having a slow puncture that no amount of strong pelvic floor contraction could overcome. This morning I woke with a full pad which has never been the case since the catheter came out. Leaky again today.

I can only guess that the events leading to the bleed have shifted something, or that the there is some inflammation at the ?strained anastomosis and it will settle with time and PFE's. 

Thanks.

User
Posted 20 Mar 2016 at 12:35
W

When doing a long post select and copy the text before hitting post, if it hangs you can start again and paste the text into the new post.

I had a bladder pressure test a few weeks ago which involved putting a pipe into my bladder, in the following few days the continence improved dramatically. If you look at the mechanics of your replumbed pipes logic would say some debris in the sphincter would make you leak like a sieve. In the past 24 hours I have been totally dry, let's hope it lasts. I have not done a PFE since mid Jan,not suggesting you give up on them and bear in mind this second bout of incontinence is not a direct result of the RARP.

I assume your question on strain was to the other Chris.

Thanks Chris

User
Posted 20 Mar 2016 at 13:23

Thanks for the advice re; long posts.

I'm pinning my hopes for recovery of continence on the notion of  the lining of the pipe being altered by mechanical strain My thinking is that this has led to bleeding and inflammation, which has altered the sealing properties of the bore of the urethra. A bit like your 'debris' mechanism. I'll rest and see if the reduced bleed is accompanied by improved continence. I did find a pukka article on the where the author commented on the importance of the sponginess of the walls of the urethra as important for sealing to create continence.

It sounds a bit like practical mechanics.  I get the feeling you have that analytical /practical mindset.  I had the image of you being into classic bikes when you mentioned debris in pipes. Think I'm getting my impressions mixed up- just remembered it's Kevan of this parish who rides an old (1950's) motorbike in his avatar.

Yes the 'Strain' part of my posting was aimed to Chris J, and since dealt with by PM.

User
Posted 23 Sep 2018 at 11:13

I know this is not a current thread but so much relates to my recent and current experience...

I was nearly 3 weeks post RALP when I experienced bloody urine. It began with the occasional drop or two of bloody urine followed by an incident of a lot of blood followed by an hour or two of being obstructed. The obstruction cleared with a bit of effort or straining which dislodged a clot of blood into the loo. Quite alarming at the time!

The hospital advised to stop taking the clexane - I was fully mobilised and had already gone back to work at this point. They advised that a new scab would form and this would do its work for 10 days or so and then break up. Things settled down and, 2 weeks on, no more blood has appeared.

I'm now experiencing restricted and uncomfortable urination. I am fairly sure the flow rate isn't as good as it was a week or so ago.

What are people's thoughts? Might this be debris that is obstructing and stressing the new joint? Might it be a stricture related to the joint not healing smoothly? Both mechanisms were mentioned in the thread.

User
Posted 23 Sep 2018 at 18:11

M

Welcome to the forum. Your issues could be any of the problems you mention or even a water infection. On one hand you are probably still recovering from all the trauma of the surgery and need a bit more time for things to settle. On the other hand I had had my first dilatation within 14 weeks of surgery. My first symptoms was foul smelling urine and a yellow discharge, followed by slow and uncomfortable  urination.

At 4 weeks my ED guy suspected a stricture, at six weeks my surgeon dismissed the idea of a stricture, as they say the rest is history. Some might say it is way too early but you could start checking your flow.

If the problem persists you will probably be asked to do an intake output chart for three days in which you record the type of drink, it's volume and time. You then record your urine output volume and time. 

To test the flow rate measure the amount urinated and divide by the seconds it take to urinate , e.g. 300 ml/ 30 secs equals 10 ml per second. I did get down to 0.5mls per sec, one of our members has had a flow rate of 5mls per second for a few years.

How much are you passing and how often, how is your continence. Keep drinking plenty of water, caffeine can have an adverse effect on the bladder.

You may want to start a new conversation and keep all your posts and replies in the same place.

As I always say in these situations, if in doubt consultant your medical team.

Thanks Chris

User
Posted 27 Sep 2018 at 21:45

Thanks for the reply. I have contacted the urologists and I think that dilatation is in prospect. The discomfort is stable (probably for the last couple of weeks) and inhibits urination. If I hold back then I have enough flow and it doesn't hurt. If I just let it go then it hurts like hell.

Continence is good. Practically dry after 6 weeks. :-) I'm drinking plenty and am feeling fitter than I was pre-op. I can now last an hour or two between pees but urination is slow but more than just a dribble.

I'm now thinking that the blood was related to the stricture tearing. Now it is holding together and obstructing the urethra. Presumably structures vary from case to case?

User
Posted 27 Sep 2018 at 23:43

RC

My surgeon is convinced that my stricture was caused by the trauma of having my catheter swiftly pulled out when it got stuck. Strictures amongst other things can be caused by over tightened sutures or urine passing through the healing tissue, that is why they test the anastomosis to make sure it is water tight. In my case the stricture was a build up of scar tissue within the urethra. You could have pulled on the joint ,but not sure it is that easy to do. Strictures seem quite common with robotic surgery, in my unqualified opinion I wonder if it is related to the technique. The Davinci robot used in my op is just over four years old and did not have tactile feedback at the controls, apparently the later versions do.

Hope you have an easier path through your solution to the problem the I did. Best wishes.

Thanks Chris

User
Posted 28 Sep 2018 at 16:33

That is a VERY interesting comment. I was reduced to a quivering heap when the catheter was removed. The pain was very bad - I had catheters removed before (after hip surgery) with no pain at all. I will discuss with surgeon when I see him in 10 days time.

 
Forum Jump  
Email this conversation Print this conversation

Join the online community now.

Click through to become a member and gain access to support, information and real time replies.




MenuTop ▲
©2024 Prostate Cancer UK