Macroscopic haematuria--a urological approach

Haematuria is a common symptom with a multitude of differentials. It can often be a diagnostic dilemma.

This article looks at the role of the general practitioner in the investigation and initial management of macroscopic haematuria.

Common urological causes of haematuria include urinary tract infection and ureteric and renal stones, but concurrent pathology should be suspected if haematuria is significant or persistent. Importantly, if benign conditions are excluded, and the haematuria continues, further investigation is advised, as this may be the only sign of an underlying genitourinary malignancy. Recommended investigations for haematuria include computed tomography intravenous pyelogram, urine cytology, urine microscopy and culture and blood tests (full blood examination, renal function and, in men, prostate-specific antigen). Patients with risk factors for genitourinary malignancy, macroscopic haematuria or those in whom no cause is found, should be referred to a urological service for further investigation including cystoscopy. Acute urinary retention is a common acute presentation of macroscopic haematuria. This can be managed with continuous irrigation and rarely requires emergency surgical intervention.