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Visible haematuria associated with confirmed urinary tract infection — MSRA MCQ

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ModerateHematuriaVisible haematuria associated with confirmed urinary tract infectionMSRA

A 51-year-old woman presents with 3 days of dysuria, urinary frequency and visible haematuria. She has no loin pain, fever, vomiting, vaginal bleeding or recent urinary instrumentation. A midstream urine sample collected before antibiotics grows >10⁵ CFU/mL Escherichia coli susceptible to first-line oral treatment. Her eGFR is 82 mL/min/1.73 m² and she is otherwise well. She has never previously had visible haematuria. What is the most appropriate management plan today?

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Correct answer: B — Treat the urinary tract infection according to culture susceptibility, with review to ensure that the visible haematuria resolves; use a suspected cancer pathway referral if haematuria persists or recurs after successful treatment

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

This episode of visible haematuria occurs concurrently with a microbiologically confirmed symptomatic urinary tract infection. In this setting, the immediate priority is culture-directed treatment of the UTI and confirmation that both symptoms and haematuria resolve. NICE recommends suspected cancer pathway referral in people aged 45 years and over when visible haematuria is unexplained without UTI, or when it persists or recurs after successful UTI treatment. Her haematuria is currently explained by infection and has not yet been shown to persist or recur. B is premature because the referral threshold following UTI requires persistent or recurrent visible haematuria after successful treatment. C is inappropriate in a clinically stable patient without sepsis, obstruction or renal colic. D may become relevant following specialist assessment or if haematuria does not resolve, but routine ultrasound is not the recommended first step in this presentation. E provides inadequate safety-netting: visible haematuria must be actively reviewed after treatment rather than deferred for 6 months.

Reference: NICE NG12: Suspected cancer: recognition and referral — recommendations organised by site of cancer (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