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Visible haematuria persisting or recurring after treated UTI — MSRA MCQ

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HardUrinary Tract InfectionsVisible haematuria persisting or recurring after treated UTIMSRA

A 52-year-old woman was treated 3 weeks ago for culture-confirmed Escherichia coli lower UTI. She had dysuria, frequency and visible haematuria; the organism was susceptible to nitrofurantoin, which she completed as prescribed. Her dysuria and frequency resolved within 48 hours. Seven days after completing treatment, she has had two further episodes of painless visible haematuria. She has no dysuria, frequency, fever, loin pain, vaginal bleeding or recent vigorous exercise. A repeat midstream urine culture is negative. Renal function is normal. What is the most appropriate next management step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Refer using a suspected cancer pathway for urological assessment

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

This woman requires referral using a suspected cancer pathway. She is over 45 years old and has visible haematuria that has recurred after successful treatment of a microbiologically confirmed UTI. The repeat negative culture and absence of lower or upper UTI symptoms make ongoing infection an unsuitable explanation. NICE recommends suspected cancer pathway referral in this situation because visible haematuria may indicate bladder or renal cancer. B is insufficient: non-urgent referral may be considered for recurrent or persistent unexplained UTI in people aged 60 years and over, but this presentation is recurrent visible haematuria after treated infection. C risks delaying assessment; repeat testing is not required before referral when the referral criterion is already met. D is inappropriate because there is no clinical or microbiological evidence of persistent infection. E may form part of specialist diagnostic assessment, but imaging should not be used to defer the indicated suspected cancer pathway referral.

Reference: Suspected cancer: recognition and referral (NG12) — recommendations organised by site of cancer (2015, updated 2026) — https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer Kidney cancer (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