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Recurrent visible haematuria after treated urinary tract infection — MSRA MCQ

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HardLUTSRecurrent visible haematuria after treated urinary tract infectionMSRA

A 67-year-old man with stable benign prostatic enlargement treated with tamsulosin presents with 5 days of dysuria, increased frequency and visible haematuria. Midstream urine culture grows Escherichia coli susceptible to nitrofurantoin. He completes a 7-day course with resolution of dysuria and frequency. Ten days later, he reports a further episode of painless visible haematuria. He is afebrile and systemically well. Repeat urine culture is negative. eGFR is 72 mL/min/1.73 m² and digital rectal examination demonstrates a smoothly enlarged prostate. What is the most appropriate next management step?

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Correct answer: A — Refer using a suspected cancer pathway for bladder or renal cancer

This man requires a suspected cancer pathway referral. He is over 45 years old and has recurrent visible haematuria after successful treatment of a culture-confirmed UTI. NICE recommends suspected cancer pathway referral for bladder and renal cancer in this situation. His established benign prostatic enlargement and smooth prostate do not adequately explain recurrent visible haematuria, and should not defer cancer assessment. A renal and bladder ultrasound may form part of secondary-care assessment, but arranging imaging in primary care instead of referral risks delaying the required pathway. Repeating culture is reasonable when infection remains suspected, but the repeat sample is already negative and the haematuria has recurred after treatment. Finasteride may be appropriate for progressive LUTS in selected men with an enlarged prostate, but it is not an appropriate explanation-led response to recurrent visible haematuria. Routine urology referral is insufficient because he meets NICE criteria for urgent suspected cancer assessment.

Reference: Suspected cancer: recognition and referral (NG12) — recommendations organised by site of cancer (Updated 2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer Kidney cancer quality standard QS215 — Quality statement 1: suspected cancer pathway referral (19 March 2026) — https://www.nice.org.uk/guidance/qs215/chapter/Quality-statement-1-Suspected-cancer-pathway-referral Lower urinary tract symptoms in men: management (CG97) — recommendations (2010) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations