• Microscopic Hematuria (> 2 RBC on high power )

  • Assess and treat for UTI
  • Re-assess → persistent: work-up for Bladder Cancer - TCC

• Gross Hematuria

  • Bladder Cancer - TCC until proven otherwise!
  • Renal Cancer - RCC and Prostate cancer possible
  • Younger patient: More likely renal issues, e.g. UTI (more common than TCC)

  Condition	Key Risk Factor	Key Signs & Symptoms	Complications	Imaging Approach -> Sign
  Renal Cancer (RCC)	Smoking, hypertension, genetic conditions (e.g., VHL), PMHx and FHx, cystic disease (ARCD)	Mostly asymp., Triad of painless gross hematuria, flank pain, flank mass, +/- constitutional symp

  | Metastasis | 1. US to ID the bleeder, 2. CT with IV contrast (multiphase renal mass study) after bleeding resolves | | Bladder Cancer (TCC) | Smoking, age >50 years, male, occupational exposure, Cyclophosphamide | Painless gross hematuria, frequency & urgency, +/- abdo pain & constitutional symp | Metastasis | 1. US to ID the bleeder, 2. CT with IV contrast (CT urogram) after bleeding resolves |

Investigation

1. US to ID the bleeder (if actively bleeding)
2. CT with IV contrast (CT urogram) after bleeding resolves
3. Cystoscopy

• Don’t do Biopsy → unnecessary

For < 40 AND No RF, Microscopic Hematuria (? UTI, stone)

• Urine Cytology → Part of UA
• Renal US

For [Gross] OR [> 40 AND/OR RF, Microscopic Hematuria] (? TCC)

• Cystoscopy [Dx]
• CT Urogram
• Urine Cytology→ Part of UA

Full DDx

Management

• For gross hematuria in hospital
  • CBI - Continuous Bladder Irrigation to prevent clot formation