Haematuria

Haematuria is one of the commonest reasons for urological referral in an adult population and can be classified as visible and non-visible. Haematuria can be a sign of urological malignancy and therefore requires urgent assessment. A one-stop clinic staffed with the appropriately trained personnel with access to radiological investigations is usually a cost-effective method of delivering a timely service. Initial assessment of these patients requires a thorough history and physical examination followed by urine and blood tests. To identify the cause of bleeding, a combination of upper tract imaging and cystoscopy is required. The choice of upper tract imaging is controversial, with computed tomography (CT) urography representing the most sensitive single test, at the expense of radiation dose. Alternative approaches commonly followed include ultrasonography and kidneys, ureters and bladder (KUB) X-ray, reserving urography (CT or conventional) for high-risk cases. In almost all cases, haematuria can be dealt with in an out-patient setting, with admission reserved for those with catastrophic bleeding leading to clot retention and/or symptomatic hypovolaemia. In the emergency setting, patients presenting with gross haematuria or clot retention require catheterization and irrigation alongside resuscitation. Definitive management will depend on the underlying cause, but is preferably carried out during the same admission.