Visible (gross) haematuria in an adult carries a meaningful risk of urothelial or renal cancer, and the common error is attributing it to a urinary infection or anticoagulation and stopping there.
Evaluate any episode of visible haematuria in an adult with cystoscopy and upper-tract imaging, preferably CT urography, even if the patient is on an anticoagulant or antiplatelet: these drugs unmask bleeding from a tumour rather than cause it. A coexisting urinary tract infection does not remove the need to investigate once the infection is treated and haematuria persists or was not clearly infection-related.
For microscopic haematuria, risk-stratify rather than investigate everyone: age, smoking history and degree of haematuria guide whether cystoscopy and imaging are warranted. The principle is simple: do not let a convenient explanation close off the cancer workup that visible haematuria demands.
- Investigate any visible haematuria in an adult with cystoscopy and upper-tract imaging (CT urography).
- Do not attribute visible haematuria to anticoagulation; these drugs unmask tumour bleeding rather than cause it.
- A treated urinary infection does not remove the need to investigate persistent or unexplained haematuria.
- For microscopic haematuria, risk-stratify by age, smoking and degree before deciding on full workup.
Why it matters
Dismissing visible haematuria as infection or anticoagulation is a common way bladder and upper-tract cancers are missed until later.
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