What is the appropriate investigation for haematuria?
Most patients with haematuria need to be carefully evaluated to exclude serious pathology. Exceptions include low-risk patients with low-volume microscopic haematuria, or haematuria clearly associated with a UTI that disappears after successful treatment of the infection. Anti-coagulant associated haematuria also deserves investigation, since it may still be a sign of serious underlying pathology. In addition to a full clinical assessment, investigation of haemtauria needs to include urianry cytology, imaging of the upper urinary tract and visualisation of the lower urianry tract by cystoscopy. CT-IVP is the imaging study of choice for haematuria, and provides excellent sensitivity for small parenchymal or collecting system lesions. Ultrasound may be a reasonable alternative in low-risk patients (although it has lower sensitivity), since it avoids the cost and risk associated with CT.
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