Is it necessary to perform urine cytology in screening patients with haematuria?

All patients with gross haematuria and those older than 50 years with microscopic haematuria need investigations to rule out the presence of a urological malignancy. OBJECTIVE: To study the role of urine cytology in the evaluation of patients with haematuria. METHODS: Two hundred and eighty-five patients were evaluated. All patients underwent evaluation including urine cytology, flexible cystoscopy, ultrasonography and/or IVU. RESULTS: The mean age of the patients was 62.4 years. Sixty-five percent had gross and 35% microscopic haematuria. Fifty-five tumours were discovered (19.2%); of these 48 were transitional cell carcinomas, 3 renal cell carcinomas and 3 carcinomas of the prostate. Thirty-seven urinary cytologies were abnormal. The overall sensitivity of urinary cytology was 42.4% and specificity 94.3%. Of 18 patients with positive cytology, all were found to have transitional cell carcinomas on cystoscopy or imaging. Of 19 patients with suspicious cytologies, only 6 were found to have tumours. The remaining 13 patients had no evidence of tumour on combined upper tract imaging (IVU and ultrasound) or on rigid cystoscopy and bladder biopsy. Whilst all the other investigation modalities contributed to diagnoses (and/or exclusion of tumours), no additional tumours were discovered solely by urinary cytology. A moderate cost saving could be made without compromising diagnostic accuracy. CONCLUSION: Our study suggests that performing routine urine cytology is not relevant in the investigation of patients with haematuria, its role is at best supportive.     

Is microscopic haematuria a urological emergency?

OBJECTIVE: To determine the prevalence of urological pathology in a retrospective and prospective study of patients with microscopic haematuria attending a haematuria clinic. PATIENTS AND METHODS: Between January 1998 and May 2001, 781 patients attended the haematuria clinic; of these, 368 (47%; median age 60 years, range 18-90) had a history of microscopic haematuria, as detected by urine dipstick testing. These patients were investigated by urine culture and cytology, renal ultrasonography, intravenous urography (IVU), flexible cystoscopy, urea and electrolyte analysis, and assay of prostate specific antigen (PSA) where appropriate. RESULTS: Urine cytology showed no malignant cells in any patient with a history of microscopic haematuria. In 143 patients (39%), urine cytology showed no red blood cells and all other investigations were normal. Of the remaining 225 patients, IVU showed a tumour in one (bladder), renal stones in 15 and an enlarged prostate in two. Renal ultrasonography detected no additional pathology. Urine analysis showed one urinary tract infection. Flexible cystoscopy detected five patients with a bladder tumour (all G1pTa), two urethral strictures, five bladder stones and enlarged prostates, six enlarged prostates only, and nine red patches in the bladder, showing one patient with carcinoma in situ. No PSA levels were suggestive of prostate cancer. CONCLUSION: Patients with dipstick-positive haematuria should be re-assessed by urine microscopy before referral. As only 1.4% of patients had a malignant pathology (all noninvasive), microscopic haematuria should be regarded as a separate entity from macroscopic haematuria, and such patients do not need to be referred urgently.     

Haematuria

Haematuria is a common presenting symptom and can be classified as either dipstick, microscopic or macroscopic. It is one of the commonest reasons for referring patients for urological evaluation and should always be taken seriously. Just under half of all patients with haematuria are found to have significant underlying pathology, many of whom have a urological malignancy. Therefore all adults with haematuria should be assumed to have a urological malignancy until proven otherwise. The commonest malignant cause of haematuria in adults over the age of 50 years is bladder cancer followed by renal cell cancer. Benign causes are primarily attributed to urinary tract infection and renal stone disease. Evaluation of patients with haematuria includes a focussed history and physical examination, urinalysis and various blood tests. Most importantly the lower urinary tract should be visualized using cystoscopy, usually using a flexible scope, and the upper tract imaged by a combination of modalities including plain X-ray, ultrasonography, intravenous urography or computed tomography urography. The treatment options for haematuria depend on the underlying cause.     

Haematuria investigation based on a standard protocol: emphasis on the diagnosis of urological malignancy

OBJECTIVE: To audit the findings of a standard investigation protocol for haematuria with emphasis on the diagnosis of urological malignancy. METHODS: Data were prospectively collected on haematuria referrals to one centre over a 5 year period. The standard protocol of investigation included flexible cystoscopy, urine cytology and culture, upper tract imaging, consisting of a renal tract ultrasound scan and a radiograph of kidney-ureter-bladder (KUB), proceeding to an intravenous urogram (IVU) in selected patients. RESULTS: 1046 patients were examined; 63% (n = 657) had microscopic haematuria and 37% (n = 389) had frank haematuria. No malignancy was found in patients with microscopic haematuria below 50 years of age. The findings of malignancy were not associated with either the sex or duration of symptoms in either groups. No association between the presence of symptoms and the finding of malignancy was observed in the microscopic haematuria group. Twenty five percent of patients presenting with frank haematuria had malignancy compared with 3.7% of patients with microscopic haematuria (p < 0.0001). The type of haematuria (frank or microscopic) was not predictive of grade or stage of malignancy. Of patients under 70 years with frank haematuria, males were more likely than females to have malignancy. This higher risk was not observed in older patients. Urine cytology had a poor predictive value for detection of malignancy with a sensitivity of only 25%. CONCLUSION: Full investigation of all patients with frank haematuria and those with microscopic haematuria above 50 years of age, is well justified. Patients under 50 years with microscopic haematuria should have a lower priority for investigation.     

Immunocytology in the assessment of patients with painless gross haematuria

OBJECTIVE

To evaluate, in a prospective study, the role of immunocytology in assessing patients with gross haematuria. Due to the high prevalence of urothelial cancer in this population, a thorough assessment is mandatory to identify all patients with tumours.

PATIENTS AND METHODS

We used Ucyt® (DiagnoCure Inc., Quebec, Canada), a commercially available immunocytological assay based on the microscopic detection of tumour‐associated antigens on the membrane of urothelial cells by immunofluorescence. Between October 2000 and March 2007, 61 consecutive patients with a first episode of painless gross haematuria, but no previous transitional cell carcinoma, were included. Urine samples were obtained from all patients and examined cytologically and immunocytologically.

RESULTS

Clinically (by physical examination, laboratory tests, endoscopy and imaging) there was bladder cancer in 17 patients (28%); further diagnoses were benign prostatic enlargement (20, 33%), urinary tract infection (seven, 12%), urolithiasis (two, 3%), and ‘further conditions’ (seven, 12%). In 10 patients (16%) the reasons for haematuria were not disclosed. Of the 61 samples, 59 (97%) were assessable by cytology and immunocytology. For cystoscopy, immunocytology and conventional urine cytology the sensitivity was 76%, 88% and 47%, and the specificity 100%, 77% and 95%, respectively. Two bladder tumours were not detected by cystoscopy and immunocytology (one each), and two upper urinary tract tumours were diagnosed by imaging and immunocytology.

CONCLUSIONS

The combination of cystoscopy and immunocytology gave 100% sensitivity, while combining cystoscopy and cytology only marginally improved the sensitivity of cystoscopy alone. As sensitivity appears to be of key relevance in assessing patients with gross haematuria, we suggest adding immunocytology to the diagnostic protocol in this situation.     

The role of urine cytology in the assessment of lower urinary tract symptoms.

OBJECTIVE: To evaluate the role of urine cytology in the investigation of men with lower urinary tract symptoms (LUTS) in the absence of haematuria. PATIENTS AND METHODS: The study comprised 336 men attending a LUTS assessment clinic, who had neither macroscopic nor microscopic haematuria. One sample of urine was collected for cytology. Those with suspicious urine cytology were investigated with intravenous urography and cystoscopy. RESULTS: Five men had abnormal urine cytology results; on further investigation one of them was found to have carcinoma in situ (CIS) and one to have a transitional cell carcinoma. Three had false-positive urine cytology results. CONCLUSION: A bladder tumour or CIS was detected in 0.6% of the population tested. The cost per cancer diagnosed was GB pound 2020. Urine cytology is a simple noninvasive way of assisting accurate diagnosis of men who have LUTS in the absence of haematuria.     

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Haematuria clinics with same day imaging and flexible cystoscopy are an efficient way for investigating patients with haematuria. The principal role of haematuria clinics with reference to bladder cancer is to determine which patients are ‘normal’ and may be discharged, and which patients are abnormal and should undergo rigid cystoscopy. It is well recognised that CT urography offers a thorough evaluation of the upper urinary tract for stones, renal masses and urothelial neoplasms but the role of CT urography for diagnosing bladder cancer is less certain. The aim of the present study was to evaluate the diagnostic accuracy of CT urography in patients with visible haematuria aged >40 years and to determine if CT urography has a role for diagnosing bladder cancer. This study shows that the optimum diagnostic strategy for investigating patients with visible haematuria aged >40 years with infection excluded is a combined strategy using CT urography and flexible cystoscopy. Patients positive for bladder cancer on CT urography should be referred directly for rigid cystoscopy and so avoid flexible cystoscopy. The number of flexible cystoscopies required therefore may be reduced by 17%. The present study also shows that the diagnostic accuracy of voided urine cytology is too low to justify its continuing use in a haematuria clinic using CT urography and flexible cystoscopy.

OBJECTIVES

• ? To evaluate and compare the diagnostic accuracy of computed tomography (CT) urography with flexible cystoscopy and voided urine cytology for diagnosing bladder cancer.
• ? To evaluate diagnostic strategies using CT urography as: (i) an additional test or (ii) a replacement test or (iii) a triage test for diagnosing bladder cancer in patients referred to a hospital haematuria rapid diagnosis clinic.

PATIENTS AND METHODS

• ? The clinical cohort consisted of a consecutive series of 778 patients referred to a hospital haematuria rapid diagnosis clinic from 1 March 2004 to 17 December 2007. Criteria for referral were at least one episode of macroscopic haematuria, age >40 years and urinary tract infection excluded. Of the 778 patients, there were 747 with technically adequate CT urography and flexible cystoscopy examinations for analysis.
• ? On the same day, patients underwent examination by a clinical nurse specialist followed by voided urine cytology, CT urography and flexible cystoscopy. Voided urine cytology was scored using a 5‐point system. CT urography was reported immediately by a uroradiologist and flexible cystoscopy performed by a urologist. Both examinations were scored using a 3‐point system: 1, normal; 2, equivocal; and 3, positive for bladder cancer.
• ? The reference standard consisted of review of the hospital imaging and histopathology databases in December 2009 for all patients and reports from the medical notes for those referred for rigid cystoscopy. Follow‐up was for 21–66 months.

RESULTS

• ? The prevalence of bladder cancer in the clinical cohort was 20% (156/778). For the diagnostic strategy using CT urography as an additional test for diagnosing bladder cancer, when scores of 1 were classified as negative and scores of 2 and 3 as positive, sensitivity was 1.0 (95% confidence interval [CI] 0.98–1.00), specificity was 0.94 (95% CI 0.91–0.95), the positive predictive value (PPV) was 0.80 (95% CI 0.73–0.85) and the negative predictive value (NPV) was 1.0 (95% CI 0.99–1.00).
• ? For the diagnostic strategy using CT urography as a replacement test for flexible cystoscopy for diagnosing bladder cancer, when scores of 1 were classified as negative and scores of 2 and 3 as positive, sensitivity was 0.95 (95% CI 0.90–0.97), specificity was 0.83 (95% CI 0.80–0.86), the PPV was 0.58 (95% CI 0.52–0.64), and the NPV was 0.98 (95% CI 0.97–0.99). Similarly using flexible cystoscopy for diagnosing bladder cancer, if scores of 1 were classified as negative and scores of 2 and 3 as positive, sensitivity was 0.98 (95% CI 0.94– 0.99), specificity was 0.94 (95% CI 0.92–0.96), the PPV was 0.80 (95% CI 0.73–0.85) and the NPV was 0.99 (95% CI 0.99–1.0).
• ? For the diagnostic strategy using CT urography and flexible cystoscopy as a triage test for rigid cystoscopy and follow‐up (option 1), patients with a positive CT urography score are referred directly for rigid cystoscopy, and patients with an equivocal or normal score were referred for flexible cystoscopy. Sensitivity was 1.0 (95% CI 0.98–1.0), specificity was 0.94 (95% CI 0.91–0.95), the PPV was 0.80 (95% CI 0.73–0.85), and the NPV was 1.0 (95% CI 0.99–1.0).
• ? For the diagnostic strategy using CT urography and flexible cystoscopy as a triage test for rigid cystoscopy and follow‐up (option 2), patients with a positive CT urography score are referred directly for rigid cystoscopy, patients with an equivocal score are referred for flexible cystoscopy and patients with a normal score undergo clinical follow‐up. Sensitivity was 0.95 (95% CI 0.90–0.97), specificity was 0.98 (95% CI 0.97–0.99), the PPV was 0.93 (95% CI 0.87–0.96), and the NPV was 0.99 (95% CI 0.97–0.99).
• ? For voided urine cytology, if scores of 0–3 were classified as negative and 4–5 as positive for bladder cancer, sensitivity was 0.38 (95% CI 0.31–0.45), specificity was 0.98 (95% CI 0.97–0.99), the PPV was 0.82 (95% CI 0.72–0.88) and the NPV was 0.84 (95% CI 0.81–0.87).

CONCLUSIONS

• ? There is a clear advantage for the diagnostic strategy using CT urography and flexible cystoscopy as a triage test for rigid cystoscopy and follow‐up (option 1), in which patients with a positive CT urography score for bladder cancer are directly referred for rigid cystoscopy, but all other patients undergo flexible cystoscopy.
• ? Diagnostic accuracy is the same as for the additional test strategy with the advantage of a 17% reduction of the number of flexible cystoscopies performed.
• ? The sensitivity of voided urine cytology is too low to justify its continuing use in a hospital haematuria rapid diagnosis clinic using CT urography and flexible cystoscopy.

     

Is Routine Urine Cytology Useful in the Haematuria Clinic?

INTRODUCTION

The objective of this study was to determine the value of routine urine cytology in the initial evaluation of patients presenting to a one-stop haematuria clinic.

PATIENTS AND METHODS

A total of 1000 consecutive patients who attended the haematuria clinic between June 2003 and November 2004 were studied prospectively. A standard protocol was used to investigate these patients. This included urine cytology, upper tract imaging and flexible cystoscopy.

RESULTS

Overall, 986 samples of urine were sent for cytology. In 126 patients, the report was abnormal; of these, 71 patients were found to have bladder transitional cell carcinoma by flexible cystoscopy and a further 3 had upper tract transitional cell carcinoma diagnosed radiologically. The remaining 52 patients with abnormal cytology were not found to have cancer on further investigations. The total cost for urine cytology and additional investigations was £50,535.

CONCLUSIONS

In this study of the initial evaluation of patients with haematuria, no case of urothelial malignancy was diagnosed on the basis of urine cytology alone. Therefore, urine cytology need not be used routinely in the initial diagnostic workup for haematuria.     

膀胱镜检查与医源性尿路感染

为研究膀胱镜检查与医源性尿路感染的关系以及预防性应用抗菌药的意义,本文总结了117例膀胱镜检查资料,提出对检查前非感染尿病人,检查后不必常规预防性应用抗菌药;对检查前感染尿病人而尿细菌培养阴性者,建议检查后预防性应用抗菌药;对检查前尿细菌培养阳性者,尤其对于尿路梗阻或拟行输尿管插管的病人,建议检查前后应用有效的抗菌药。     

Identification of the source of haematuria by automated measurement of mean corpuscular volume of urinary red cells

The appearance of red blood cells in the urine may be the result of disease of any segment of the urinary tract. To determine whether there might be a distinguishing characteristic of the urinary red cells which appear during glomerular disease but is absent in other urinary tract diseases, the mean corpuscular volumes (MCV) of urinary and blood erythrocytes were measured by a Coulter counter in 34 children with haematuria. Diagnosis of the underlying renal or urinary tract disease was made by clinical and laboratory findings, including radiological investigations, renal biopsy and cystoscopy. The ratio of the urinary erythrocyte MCV to that in blood (U_mcv/B_mcv) was compared with the diagnosis. The U_mcv/B_mcv ratio was less than 1.0 in all children with glomerular disease and was greater than 1.0 in all but 1 of the patients with non-glomerular disease. This study suggests that the U_mcv/B_mcv ratio provides a simple and useful technique for distinguishing between glomerular and non-glomerular haematuria. Such determination would help in guiding appropriate diagnostic evaluation.     

Indication of cystoscopy in patients with asymptomatic microscopic haematuria

To establish the appropriate indication of cystoscopy in patients with asymptomatic microscopic haematuria, we reviewed 263 cases with positive reaction for urinary dipstick test on annual health screening examination. On initial examination, 18 highly significant lesions, 52 moderately significant lesions and 38 insignificant lesions were detected. No underlying lesion could be found in 96 patients and no microscopic haematuria in 59 patients. However, bladder cancers were detected in only 8 (3.0%) cases. All patients with bladder cancer were older than 40 years. These facts suggest that cystoscopy is not necessary for patients with a single microscopic haematuria and those younger than 40 years.     

Photodynamische Diagnostik des Harnblasenkarzinoms

The question whether conventional cystoscopy should always be performed together with fluorescent diagnostic procedures remains to be answered. The current article presents the current literature dealing with this topic. Particularly for relevant carcinoma in situ lesions of the bladder there is no obvious advantage for photodynamic diagnostics compared to conventional cystoscopy with consistent use of urine cytology.     

The value of cystourethroscopy in the investigation of microscopic haematuria in adult males under 40 years. A prospective study of 100 patients

Microscopic haematuria is a common finding in young men. Controversy exists as to its significance and how it is best investigated. A prospective study of 100 young men under the age of 40 with microscopic haematuria has been performed. A positive diagnosis was made in 32 patients. Cystourethroscopy was of diagnostic value in only 3 patients and of therapeutic value in a further 3. It was concluded that cystourethroscopy is of minimal diagnostic value in young men with microscopic haematuria. Its routine use is unnecessary and should be reserved for those patients in whom investigation suggests that a treatable cause may be found in the lower urinary tract.     

A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice

PURPOSE: The commonly accepted diagnostic algorithm for hematuria includes excretory urography (IVP) and cystoscopy. Some have suggested that ultrasound of the upper urinary tract is adequate and that cystoscopy is not necessary in younger patients with microscopic hematuria. We ascertain whether a less intensive algorithm could be adopted while retaining diagnostic efficacy. MATERIALS AND METHODS: A total of 1,930 patients were enrolled prospectively in the study at a hematuria clinic between October 1994 and March 1997. Evaluation consisted of basic demographics, history and examination, routine blood tests, urinalysis and cytology. All patients underwent plain abdominal radiography, renal ultrasound, IVP and flexible cystoscopy. RESULTS: A total of 1,194 males and 736 females with a mean age of 58 years (range 17 to 96) were included in the study. Overall, 61% of patients had no basis found for hematuria, 12% had bladder cancer, 13% had urinary tract infection and 2% had stones. Kidney and upper tract tumors were noted in 14 patients (0.7%), including 4 who presented with microscopic hematuria. If only ultrasound or IVP had been performed 4 of these cases would have been missed. Of 982 patients presenting with microscopic hematuria 51 had cancer. Bladder cancer was found in 7 patients younger than 40 years. CONCLUSIONS: Our findings suggest that cystoscopy cannot be safely avoided even in younger patients with microscopic hematuria. Only a combination of ultrasound and IVP detected all upper tract tumors.     

Identification of the source of haematuria by automated measurement of red cell volume

The mean corpuscular volume (MCV) of urinary erythrocytes was measured by a Coulter Counter in 42 patients with asymptomatic haematuria. All patients had the source of haematuria established by a renal biopsy, cystoscopy or radiology. The mean urine MCV was significantly less in those with glomerular disease (n = 21) than in those with non-glomerular haematuria (n = 21). In every patient with glomerulonephritis, urinary erythrocytes were smaller than those in their own venous blood. Conversely, urinary red cells larger than venous blood were confined to patients with a non-glomerular source. Coulter analysis of urine provides a simple and objective aid to the diagnosis of haematuria.     

Report of case: Partial ureteral obstruction masked by diuretics during intraoperative cystoscopy

Injury to the lower urinary tract is a potential complication in all major vaginal and urogynecologic surgical procedures. Several authors have recommended the routine use of intraoperative cystoscopy during urogynecologic procedures. To evaluate possible injury to the lower urinary tract during intraoperative cystoscopy, the concomitant use of diuretics with indigo carmine dye has been advocated; efflux of dye is hypothesized to indicate functional patency of the urinary tract. This report describes a case in which a partial ureteral obstruction was present at the time of intraoperative cystoscopy--despite the observation of diuresis caused by furosemide. This case indicates that the efflux of indigo carmine-stained urine from both ureteral orifices is not conclusive evidence of the absence of ureteral insult during intraoperative cystoscopy.     

Practical use of investigations in patients with hematuria

OBJECTIVE: The majority of patients with microscopic hematuria undergo a complete evaluation resulting in negative findings. The outcome of patients with hematuria was analyzed in an effort to optimize the use of investigations. PATIENTS AND METHODS: The records for 404 patients who presented with hematuria were reviewed. Data were collected on demographics, type of hematuria, investigations, and final diagnosis. RESULTS: The hematuria was microscopic in 140 patients (35%) and gross in 264 patients (65%). In gross hematuria patients, 10% had urinary tract tumors and 12% had calculi. All patients with genitourinary tumors and 87% of patients with calculi had gross hematuria and/or > or =5 RBCs/HPF (red blood cells per high-power microscopic field) on urinalysis. The sensitivity and specificity were 94% and 6% for the dipstick urine test, 37% and 71% for urine cytology, 92% and 93% for computed tomography (CT), 50% and 95% for ultrasound scans, and 38% and 90% for intravenous pyelography, respectively. Logistic regression analysis showed that age and number of RBCs/HPF in the urinalyses were the only significant factors predicting genitourinary cancer. In patients < or =40 years old, there was one patient with malignancy and seven patients with stones. In older patients, there were 31 patients with malignancy and 32 patients with stones. CONCLUSIONS: Patients with <5 RBCs/HPF on three urinalyses are unlikely to have significant pathology and could possibly be followed up conservatively. Patients < or =40 years of age should have a noncontrast CT or ultrasound study if they present with microscopic hematuria, and a cystoscopy should be added if gross hematuria exists. In older patients, a pre- and postcontrast CT and a cystoscopy should be performed.     

Concealed haematuria--whence cometh the bleeding? A new method of localisation

Concealed haematuria is often a difficult diagnostic problem. A method for collecting isolated urine specimens from different areas of the urinary tract and subjecting them to quantitative analysis for RBCs is described. A more accurate localisation of the source of bleeding with, in the upper urinary tract, side differentiation, is thus possible. Some examples are presented as case reports.     

Congenital urethral fistula with normal anus: a report of two cases.

Congenital rectourethral or anourethral fistulae without imperforate anus in males are rare, representing less than 1% of anorectal malformations. We report our experience with two males with "N type" urethral fistulae. One, a 5-year-old boy, presented with recurrent urinary tract infections (UTIs) and passage of urine per anus. Investigations included a voiding cystourethrogram (VCUG), which demonstrated a fistula from the urethra to the anus. On physical examination, a small perianal opening was noted just outside the anus, which drained a small amount of urine after voiding. The fistula was excised via a perineal approach. The second patient is a 5-year-old boy with a long history of recurrent UTI requiring multiple hospitalizations since the newborn period. Chronic renal failure developed as a complication of repeated urinary tract infections. Investigations showed a single hydronephrotic pelvic kidney and a small bladder. He underwent numerous diagnostic and reconstructive procedures including cystoscopy and augmentation cystoplasty. Recurrent infections continued and an N type anourethral fistula was eventually diagnosed. The fistula was located between the anal canal and the membranous urethra. An anterior perineal approach was also used. Both fistulae were easily located, and reconstructive surgery of the urethra was not required. Postoperative VCUGs in both patients were normal. They have been free of infection with normal urinary continence since resection of the fistula. Congenital N type anourethral fistulae are rare, but should be considered in cases of recurrent urinary tract infections. The diagnosis may be missed by endoscopic procedures, but VCUG should demonstrate the fistulous tract.     

Makrohämaturie als Primärsymptom eines extramedullären IgM-Plasmozytoms der Harnblase

Haematuria is the most common clinical symptom of bladder cancer. Besides antibiotic treatment of a probably existing urinary tract infection, ultrasonography of the urinary organs, diagnostic cystoscopy (with biopsy if needed), and radiologic evaluation of the upper urinary tract (intravenous urography, computed tomography or magnetic resonance urography, retrograde pyelography) should be done for further evaluation. Atypical manifestations of systemic diseases with bladder infiltration could feign the clinical appearance of chronic cystitis and hinder determination of the correct diagnosis. The case of a 40-year-old man with recurrent gross haematuria due to extremely rare bladder infiltration through an IgM plasmacytoma is presented.