Investigating painless haematuria

doi:10.1136/bmj.a260

Published 9 July 2008, doi:10.1136/bmj.a260
Cite this as: BMJ 2008;337:a260

Practice

Rational Imaging

Investigating painless haematuria

Sylvia A O’Keeffe, specialist registrar¹, Sorcha McNally, specialist registrar¹, Mary T Keogan, consultant radiologist ¹

¹ St James’s Hospital, Dublin 8, Ireland

Correspondence to: S A O’Keeffe sylviaokeeffe@yahoo.co.uk

The first 150 words of the full text of this article appear below.

Learning points

All patients with painless haematuria needcystoscopy to exclude bladder cancer

All patients need imagingof the kidneys, by ultrasound or computed tomography urography,to look for renal cell carcinoma or transitional cell carcinomaof the renal pelvis

Patients with persistent haematuria anda normal ultrasound and cystoscopy or those at high risk needintravenous urography or computed tomography urography to increasethe chance of detecting transitional cell carcinoma of the ureter

Computedtomography urography is replacing ultrasound and intravenousurography where it is available, particularly in high risk patients

Computedtomography or ultrasound guided biopsy of renal lesions is becomingthe investigation of choice to avoid unnecessary nephrectomyfor benign disease

Radiofrequency ablation is a treatment optionfor renal cell carcinoma in patients who are not good candidatesfor surgery, particularly for tumours smaller than 3 cm