ABSTRACT
Macroscopic haematuria, unless obviously due to haemorrhagic cystitis, should always be taken seriously, as should persistent microscopic haematuria. Haematuria can be due to cancer, hence it is now investigated promptly by urologists in a ‘one-stop’ clinic. The typical presentation is one of painless haematuria. In concentrating urine, the kidneys also concentrate carcinogens which are excreted in urine. Diagnosis requires biopsy, normally by transurethral resection of the tumour and of the underlying detrusor muscle. The urine from all patients with haematuria should be tested for infection using a dipstick. Cystoscopy should be avoided in a patient with undiagnosed urinary infection as it could cause septicaemia. Urine microscopy is important in the investigation of both macroscopic and microscopic haematuria. The presence of dysmorphic red blood cells or casts may point to specific diagnoses.
