skip to main content

Recurrent visible haematuria after successfully treated urinary tract infection — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHematuriaRecurrent visible haematuria after successfully treated urinary tract infectionMSRA

A 48-year-old woman is reviewed 3 weeks after treatment for acute cystitis. At the initial presentation, she had dysuria, frequency and visible haematuria; a midstream urine culture grew >10⁵ CFU/mL Escherichia coli susceptible to nitrofurantoin. She completed a 3-day course of nitrofurantoin and her urinary symptoms resolved completely. Today, she reports a further episode of painless visible haematuria. She has no dysuria, frequency, fever, loin pain, vaginal bleeding, recent instrumentation or anticoagulant use. Urine dipstick is 3+ blood with negative nitrites and leucocytes. A properly collected midstream urine culture shows no significant growth. Her eGFR is 84 mL/min/1.73 m². What is the most appropriate management plan today?

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

Reveal the answer and explanation

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

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

This patient requires referral using a suspected cancer pathway. She is aged 45 years or over and has recurrent visible haematuria after successful treatment of a microbiologically confirmed UTI. Her initial haematuria could reasonably have been attributed to cystitis, but the subsequent painless episode occurs after complete clinical resolution and is accompanied by a negative culture and no pyuria. It therefore meets the NICE threshold for suspected bladder and renal cancer referral. A is inappropriate because there is no current clinical or microbiological evidence of UTI. B underestimates the urgency specified by NICE. D delays referral despite recurrent visible haematuria after treated infection; repeat testing is not required to establish the referral indication. E may form part of secondary-care diagnostic assessment or a local pathway, but arranging routine imaging instead of making the suspected cancer pathway referral risks delaying definitive urological assessment.

Reference: NICE NG12: Suspected cancer: recognition and referral — bladder cancer and renal cancer recommendations (2015; updated 2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer NICE QS215: Kidney cancer — 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