Visible haematuriaBMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-067395 (Published 01 February 2022) Cite this as: BMJ 2022;376:e067395
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The article on Visible haematuria by Madaan et al (BMJ 19th February) is excellent but revolves around most common conditions (Box 1). In practice, there are a number of other causes of haematuria which Doctors should be aware of, and these are not mentioned in the article. Also, the simplest way to classify haematuria in a practice is look at the origin at various levels of urinary system - renal, ureteral, bladder, prostate, urethral and systemic causes - because some symptoms are quite specific to the organ. Trauma, post-instrumentation, post-coital and factitious haematuria are not mentioned in this article.
In relation to UTI, one has to be very cautious while considering imaging investigations. There is no set rule for this in patients presenting with UTI. The article mentions that referral should be done if haematuria persists as per NICE guideline. Nothing stops GPs arranging ultrasound of urinary tract if they have any suspicion of stones or cancer or even CTU. On occasions another important feature of bladder cancer is associated bladder and urethral pain particularly in the absence of UTI, which again warrants further investigations or 2-week referral; also, referral could be made for suspected conditions such as interstitial cystitis.
There are host of drugs that cause haematuria, and this is not mentioned in the paper. In relation to assessment, clinical evaluation is extremely important, in particular the history and examination - conditions like frenal tears or even cancer could be easily missed if the penis is not examined properly.
The take home message for the clinicians in primary care is to get a relevant history and follow up on any patient who has haematuria, visible or invisible.
Competing interests: No competing interests