Evaluating hematuria in adults

Although most causes of hematuria are benign, urinary tract bleeding may signal the existence of a life-threatening disease. Gross and microscopic hematuria share a common differential diagnosis, including urinary tract infection, urolithiasis and bladder cancer. Clinical evaluation may be guided by the patient's age, sex, medical history and physical examination. Intravenous pyelography or sonography is usually the first procedure performed, although cystoscopy is indicated in the face of active bleeding. Those patients who remain undiagnosed after a complete evaluation should be followed with routine urinalysis and cytology to allow early detection of malignancy.