Visible Haematuria

I have been seeing a 57 M in the last few weeks. He is a new patient to the clinic. He has significant history of ETOH abuse and heavy smoker. Around 2 weeks ago, he came to me with a jar which had his urine in it. There was visible haematuria. I sent him for a renal ultrasound and it was returned normal. I was re-assured by the result until I discussed this with one of the GPs today and did a bit of reading myself.

Some key points about visible haematuria:

1. 20 % of people with haematuria has urological malignancy.
2. Visible haematuria requires urgent urology referral.
3. CT urography is the preferred imaging investigation
4. Women have a poorer outcome in bladder cancer often because of delay in investigations.
5. The following flow chart shows the recommended approach:

6. Do not delay referral because you need to wait for the investgating results

7. Risk factors for bladder malignancies:

References:

Australian Doctor How to treat series Visible haematuria.