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.


All patients with painless haematuria need cystoscopy to exclude bladder cancer
All patients need imaging of the kidneys, by ultrasound or computed tomography urography, to look for renal cell carcinoma or transitional cell carcinoma of the renal pelvis
Patients with persistent haematuria and a normal ultrasound and cystoscopy or those at high risk need intravenous urography or computed tomography urography to increase the chance of detecting transitional cell carcinoma of the ureter
Computed tomography urography is replacing ultrasound and intravenous urography where it is available, particularly in high risk patients
Computed tomography or ultrasound guided biopsy of renal lesions is becoming the investigation of choice to avoid unnecessary nephrectomy for benign disease
Radiofrequency ablation is a treatment option for renal cell carcinoma in patients who are not good candidates for surgery, particularly for tumours smaller than 3 cm


An 81 year old woman was referred by her general practitioner with . . . [Full text of this article]


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