Visible haematuria in an adult carries a meaningful risk of urothelial cancer, and the source can be the bladder or the upper tract. Cystoscopy examines the bladder; CT urography or ultrasound, depending on risk and guideline, examines the kidneys and ureters. Neither replaces the other.
A single episode that settles, or a urine infection found at the same time, is not a reason to skip the work-up once the infection has been treated and haematuria persists or recurs.
- Refer adults with visible haematuria for cystoscopy and upper-tract imaging.
- Do not stop the work-up because bleeding has settled.
- Treat a coexisting urine infection, then recheck; persistent haematuria still needs investigation.
- Ask about smoking and occupational exposure to dyes and chemicals.
Why it matters
Bleeding that stops is often the reason a cancer is diagnosed late.
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