The investigation of haematuria

Haematuria is the presence of blood within the urine and is best defined as visible or non-visible, and symptomatic or non-symptomatic. Non-visible haematuria may be further classified as microscopic or dipstick, depending on the investigation used to detect it. Around 40% of patients presenting with visible haematuria will be found to have a significant underlying cause, and around 20% of patients will be found to have an underlying urological malignancy. Many younger patients will be found to have an underlying nephrological disease. The risk of significant underlying malignancy increases with the extent of haematuria (visible versus non-visible), the absence of symptoms and various patient factors (such as rising age, smoking status, and gender). As such, haematuria is an important urological symptom that requires investigation. These investigations should include clinical assessment, urinalysis, lower urinary tract endoscopy, and upper urinary tract radiological evaluation.