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Visible haematuria after successfully treated lower urinary tract infection — MSRA MCQ

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HardUrinary Tract InfectionsVisible haematuria after successfully treated lower urinary tract infectionMSRA

A 57-year-old woman is reviewed 3 weeks after treatment for a culture-confirmed Escherichia coli lower UTI. Her dysuria, frequency and suprapubic discomfort resolved completely after a 3-day course of nitrofurantoin, to which the isolate was susceptible. Yesterday, she noticed a further episode of painless visible haematuria. She has no dysuria, frequency, fever, loin pain, vaginal bleeding, recent instrumentation or renal colic. She is not taking anticoagulants. A repeat midstream urine culture is negative. Examination is unremarkable and her renal function is normal. What is the most appropriate next step?

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

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Correct answer: A — Refer urgently using a suspected cancer pathway for bladder or renal cancer

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 an urgent suspected cancer pathway referral. She is aged over 45 years and has visible haematuria that has recurred after successful treatment of a documented UTI. Her initial infective symptoms resolved with culture-directed treatment, and the current negative culture plus absence of dysuria, fever or loin pain make persistent infection an inadequate explanation for the recurrent haematuria. A is inappropriate because a negative culture has already been obtained and referral should not be delayed while awaiting further microbiology. B may appear reasonable for non-visible haematuria or transient findings, but visible haematuria after treated UTI meets the urgent referral criterion now. C confuses the non-urgent referral criterion for recurrent or persistent unexplained UTI in people aged 60 years and over with the separate, more urgent visible-haematuria criterion. D may be appropriate if renal colic or a stone is suspected, but she has no colicky pain and imaging for calculi must not substitute for the indicated cancer-pathway referral. The key discriminator is recurrent visible haematuria following resolution of UTI, not the number of prior infections.

Reference: Suspected cancer: recognition and referral (NG12) — Recommended actions organised by symptom and findings of primary care investigations (Updated 2025) — https://www.nice.org.uk/guidance/ng12/chapter/Recommended-actions-organised-by-symptom-and-findings-of-primary-care-investigations