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Visible haematuria associated with successfully treated urinary tract infection — MSRA MCQ

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ModerateHematuriaVisible haematuria associated with successfully treated urinary tract infectionMSRA

A 68-year-old woman is reviewed 10 days after treatment for acute cystitis. At presentation she had dysuria, urinary frequency and one episode of bright-red visible haematuria. A midstream urine sample obtained before antibiotics grew >10^5 CFU/mL Escherichia coli. She completed culture-directed oral antibiotic treatment and all urinary symptoms, including the visible haematuria, resolved within 48 hours. She is now asymptomatic and has had no further visible haematuria. A repeat midstream urine culture shows no significant growth. What is the most appropriate management plan today?

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

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Correct answer: E — Do not refer on a suspected cancer pathway now; safety-net for prompt review if visible haematuria recurs

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

E is correct. The visible haematuria occurred during a microbiologically confirmed urinary tract infection and resolved promptly after successful treatment. NICE recommends a suspected cancer pathway referral for bladder and renal cancer in people aged 45 years and over with unexplained visible haematuria without UTI, or visible haematuria that persists or recurs after successful UTI treatment. Neither criterion is present at this review. She should be advised to seek prompt reassessment if visible haematuria returns, because recurrence after successful treatment would meet the referral threshold. A is tempting because visible haematuria in an older person is an important cancer symptom, but it disregards the confirmed infective cause and complete resolution. B is inappropriate because CT urography is not the required primary-care step in a patient who does not meet the referral criterion. C may seem cautious, but repeat testing does not replace clinical safety-netting and is not needed to establish the absence of recurrent visible haematuria in this asymptomatic patient. D incorrectly treats age alone as an indication for routine urology referral; age modifies the NICE threshold but does not override the requirement for unexplained, persistent or recurrent visible haematuria.

Reference: NICE NG12: Suspected cancer: recognition and referral — Recommended actions organised by symptom and findings of primary care investigations (2015; current NICE page checked August 2026) — https://www.nice.org.uk/guidance/ng12/chapter/Recommended-actions-organised-by-symptom-and-findings-of-primary-care-investigations