Painless haematuria (1/1700)

A 65yo man presents w/ painless hematuria, IVU is normal, prostate is mildly enlarged with mild frequency. What is the most appropriate next step?

a. US Abdomen
b. Flexible cystoscopy
c. MRI
d. Nuclear imaging
e. PSA

















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answer: B
why?

• All patients with painless haematuria need cystoscopy to exclude bladder cancer
• All patients need imaging of the kidneys, by ultrasound or computed tomography urography, to look for renal cell carcinoma or transitional cell carcinoma of the renal pelvis
• Patients with persistent haematuria and a normal ultrasound and cystoscopy or those at high risk need intravenous urography or computed tomography urography to increase the chance of detecting transitional cell carcinoma of the ureter