A single episode of painless visible haematuria in an adult can be the only sign of bladder or upper tract cancer, and the bleeding often stops on its own. Treating an assumed infection without culture, or attributing it to an anticoagulant, delays diagnosis.
The standard work-up is urine culture, renal function, cystoscopy and upper tract imaging, usually CT urography. Smoking and occupational exposure to dyes or rubber chemicals raise the pre-test probability.
- Refer every adult with unexplained visible haematuria for cystoscopy and upper tract imaging.
- Send urine for culture before treating presumed infection, and recheck after treatment.
- Do not attribute haematuria to anticoagulation without investigation.
- Ask about smoking and occupational chemical exposure.
Why it matters
Haematuria that stops is the one most often left uninvestigated.
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