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Visible haematuria recurring after treated urinary tract infection — MSRA MCQ

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ModerateUrologyVisible haematuria recurring after treated urinary tract infectionMSRA

A 52-year-old woman attends general practice because she has noticed visible blood in her urine twice over the past week. Six weeks ago, she had dysuria, frequency and visible haematuria; urine culture grew Escherichia coli and all symptoms resolved after culture-directed antibiotics. She is now systemically well, with no dysuria, fever, loin pain or vaginal bleeding. A repeat midstream urine culture shows no significant bacterial growth. She has never smoked. What is the most appropriate next management step?

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Correct answer: E — Refer using a suspected cancer pathway for assessment of bladder and renal cancer

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

This patient requires suspected cancer pathway referral because she is aged 45 years or over and has visible haematuria that has recurred after successful treatment of a culture-confirmed UTI. Her current negative urine culture and absence of dysuria make active recurrent infection less likely, but the referral criterion would be met even if the key issue were recurrence of visible haematuria after the previously treated infection. NICE recommends suspected cancer pathway referral in this situation for both bladder and renal cancer assessment. A is inappropriate because repeating primary-care testing delays referral once the age and post-UTI recurrence threshold is met. B is initially tempting because of the recent E. coli UTI, but there is no current clinical or microbiological evidence of infection to justify empirical antibiotics. C underestimates the required urgency: this is not a routine urology referral indication. E may appear diagnostically helpful, but urine cytology is not a gatekeeper for referral and a negative result would not safely exclude relevant malignancy. Smoking status modifies risk but does not remove the NICE referral indication.

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 (QS215), Quality statement 1: Suspected cancer pathway referral (March 2026) — https://www.nice.org.uk/guidance/qs215/chapter/Quality-statement-1-Suspected-cancer-pathway-referral