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

Answered by
Dr. Vivek Chail
and medically reviewed by iCliniq medical review team.

Hello doctor,

My doctor recommended I get an 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.

I had prostate laser surgery several years ago to improve urine flow with large prostate 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.

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Dr. Vivek Chail

MBBS., DMRD., DNB (RADIODIAGNOSIS
Radiodiagnosis Radiology

Hi,

Welcome to icliniq.com.

Prostate MRI is one of the best noninvasive techniques to asses any condition of the prostate. Gadolinium is a contrast material used for better delineation of any suspected lesions. The chances of adverse effects are higher in people who have a kidney condition. However, you may proceed with a plain MRI of the prostate to get a basic idea of any lesion of the prostate and there is research showing that Gadolinium contrast is not absolutely needed for prostate MRI.

b for evaluation of prostate. Transrectal ultrasound prostate may be done without contrast but gives less information than an MRI scan.

You may also get PSA (prostate-specific antigen) levels done and get tested for any urine infection. Regards.

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

Hello doctor,

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

Dr. Vivek Chail

MBBS., DMRD., DNB (RADIODIAGNOSIS
Radiodiagnosis Radiology

Hi,

Welcome back to icliniq.com.

You can get an MRI of the kidneys done without contrast and it is informative and will pick up most lesions. If there is any suspicious area on plain scan then contrast scan can be decided if needed based on the risk and benefits.

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

Thank you doctor,

That is most helpful. Follow-up item for the 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?

Dr. Vivek Chail

MBBS., DMRD., DNB (RADIODIAGNOSIS
Radiodiagnosis Radiology

Hi,

Welcome back to icliniq.com.

Iron tablets are ingested and go through a complex mechanism and increase the iron reserves. Taking few extra tablets on the day of MRI scan will not help much. The MRI will not show active bleeding but can show areas of bleed and collection of blood. It is not clear regarding the site of bleeding in your case.

You can do your normal exercise.

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

Thank you doctor,

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

Dr. Vivek Chail

MBBS., DMRD., DNB (RADIODIAGNOSIS
Radiodiagnosis Radiology

Hi,

Welcome back to icliniq.com.

Prolene PHS is safe during MRI scan.

Dental implants are of many types and the manufacturer might be able to give you a complete answer. However, in an individual with a dental implant, MRI can be safe or have a conditional use. Usually, it is not contraindicated. It is less likely that a dental implant will have an impact on kidney MRI scan.

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

Thank you doctor,

You are very helpful. As I mentioned, the urologist recommended an 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?

Dr. Vivek Chail

MBBS., DMRD., DNB (RADIODIAGNOSIS
Radiodiagnosis Radiology

Hi,

Welcome back to icliniq.com.

Bladder and urethra can be assessed in the prostate MRI scan.

The kidneys are located a bit higher and therefore sometimes a different set of images need to be taken for the kidneys.

For further queries consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

Hello doctor,

Thank you for the help. I shall get back with the reports of the MRI.

Dr. Vivek Chail

MBBS., DMRD., DNB (RADIODIAGNOSIS
Radiodiagnosis Radiology

Hi,

Welcome back to icliniq.com.

Do write back with an update.

Revert with more information to a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

Hello doctor,

As per our discussion, I have the results of the first MRI (abdomen area). I attach the MRI for your review. The report states the "MRI cannot exclude nonobstructing 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?

Dr. Vivek Chail

MBBS., DMRD., DNB (RADIODIAGNOSIS
Radiodiagnosis Radiology

Hi,

Welcome back to icliniq.com.

Thanks for writing back with an update. I have seen the files (attachment removed to protect patient identity). There is no large stone in the kidneys causing obstruction to the flow of urine. However, an MRI cannot show all stones less than 3 mm in size and therefore the statement is given saying that cannot exclude nonobstructing renal calculi.

A duplicated renal collecting system can increase the chances of an infection in the kidneys and can rarely be a cause for hematuria.

Have you got any urine culture test done to look for any infection in the urinary system?

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

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.

Dr. Vivek Chail

MBBS., DMRD., DNB (RADIODIAGNOSIS
Radiodiagnosis Radiology

Hi,

Welcome back to icliniq.com.

Good to know about the urine culture and cystoscopy scheduled for you.

Please send me if you have any other queries and I will send in a detailed reply.

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

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