Haematuria

Haematuria is a common presenting symptom and can be classified as either dipstick, microscopic or macroscopic. It is one of the commonest reasons for referring patients for urological evaluation and should always be taken seriously. Just under half of all patients with haematuria are found to have significant underlying pathology, many of whom have a urological malignancy. Therefore all adults with haematuria should be assumed to have a urological malignancy until proven otherwise. The commonest malignant cause of haematuria in adults over the age of 50 years is bladder cancer followed by renal cell cancer. Benign causes are primarily attributed to urinary tract infection and renal stone disease. Evaluation of patients with haematuria includes a focussed history and physical examination, urinalysis and various blood tests. Most importantly the lower urinary tract should be visualized using cystoscopy, usually using a flexible scope, and the upper tract imaged by a combination of modalities including plain X-ray, ultrasonography, intravenous urography or computed tomography urography. The treatment options for haematuria depend on the underlying cause.