I have visible blood in the urine after exercise. Do I need MRI with contrast?

Hello doctor,

My doctor recommended I get an magnetic resonance imaging (MRI) of the prostate and kidney. I have visible blood in the urine after exercise. We suspect it is a result of prostate laser surgery several years ago, but the doctor wants to rule out other sources of bleeding. I am okay with MRI's but will not agree to get an injection of Gadolinium contrast after reading the latest study showing long-term retention of this toxic material in the body. Ultrasound: I also read there is a new, safer contrast media using some type of "microbubbles" for use with ultrasound to detect blood flow. Questions: 1. From a diagnostic perspective, is it absolutely necessary to use contrast with the MRI's? 2. Would ultrasound with contrast be of diagnostic value? I appreciate any suggestions. It is very difficult for a patient to get knowledgeable answers to these types of questions. Ihad prostate laser surgery several years ago to improve urine flow with large prostate benign prostate hyperplasia (BPH). After surgery, I had visible blood in urine for nearly two months. Since then, I have been experiencing bleeding after exercise (for example, 5K run, tennis, basketball, etc.). Bleeding usually ends in few hours but recently experienced greater duration of bleeding.

Hello doctor,

Thanks for the information. I will request the prostate magnetic resonance imaging (MRI) without contrast. Is it also reasonable to have an MRI of the kidney without the gadolinium contrast?

Thank you doctor,

That is most helpful. Follow-up item for the magnetic resonance imaging (MRI)'s: 1. I am currently taking non-prescription Iron tablets (65 mg/day). In addition to building blood, iron may increase the visibility of blood on the MRI. Will extra iron in the blood be helpful to track the source of the bleeding? Would it be good to take a few extra tablets in the days prior to the test? 2. Should I discontinue vigorous exercise prior to the MRI to minimize the chance of bleeding during the exam? Or would active bleeding be helpful to diagnose the source of blood in the urine?

Thank you doctor,

I have a metal tooth implant in my mouth. Does the magnetism from an magnetic resonance imaging (MRI) near the lower body have any interaction with the mouth area? Also, I have a Prolene hernia system (PHS) mesh implanted from an inguinal hernia several years ago. Will that interfere in any way with the MRI diagnosis?

Thank you doctor,

You are very helpful. As I mentioned, the urologist recommended an magnetic resonance imaging (MRI) of the prostate and a separate scan of the kidney. From a diagnostic perspective, would it be valuable to also request a scan of the bladder/urethra or is that a subset of the prostate and/or kidney scan?

Hello doctor,

Thank you for the help. I shall get back with the reports of the magnetic resonance imaging (MRI).

Hello doctor,

As per our discussion, I have the results of the first magnetic resonance imaging (MRI) (abdomen area). I attach the MRI for your review. The report states the "MRI cannot exclude non obstructing renal calculi". I am told a kidney stone could be a source of blood in urine. If I do have a kidney stone, would it have been visible if the contrast was used with the MRI? The narrative states everything as normal except "there is an anatomic variant duplicated collecting system involving the right kidney." Can you provide any more detail? Also, does this variant increase or decrease the probability of kidney stone/bleeding?

Thank you doctor,

Yes, they took a urine sample and sent it out for a culture due to concerns. Also, plan to schedule a cystoscope exam soon.

Hi,

Thank you for the reply.

Attached is the narrative from the the second magnetic resonance imaging (MRI) (of the prostate area).

Hi doctor,

Thank you for the reply. I am a little confused. 1. The magnetic resonance imaging (MRI) narrative says the duplication involves the right kidney, but you mention duplication involving the left ureter. As I stand upright, facing forward, would the duplication be on the left or right? 2. If I understand your commentary correctly, I have two ureter tubes coming out of one of my kidneys. The tubes from the one kidney then join together to form a single tube that empties urine into the bladder.

Hi doctor,

Thank you for the reply. After many tests, it appears I have severe benign prostate hyperplasia (BPH) with an extremely large prostate (0.00519 cubic foot on MRI; 0.00699 cubic foot on ultrasound), with the source of bleeding likely "residual damage" from green light laser surgery several years ago. Several surgical solutions have been proposed, like PAE (prostate artery embolization). An interventional radiologist deploys microspheres endovascularly to block the arterial supply to the prostate using a small-diameter microcatheter. With the blood supply curbed, the prostate shrinks in size, relieving the symptoms of BPH, such as slow or weak urinary stream, urgency, and frequent urination. PAE is reportedly minimally invasive and has few negative short-term side effects. My concern is the use of fluoroscopy as part of the surgery. I believe the procedure could require the use of radiation for an extended period of 30 minutes or more. My question is, A) Is fluoroscopy similar to taking a rapid series of x-rays a few microseconds apart? B) The amount of radiation I would be exposed to in the course of 30 minutes would be equivalent to how many x-rays? (I am worried about long-term cancer or cell damage). Thank you.