A 55-year-old smoker presents with a history of five episodes of macroscopic hematuria each lasting for about 4-5 days in the past five years. Which of the following investigations should be performed to evaluate the suspected diagnosis
In this case, we should suspect carcinoma of the bladder ( transitional cell carcinoma ). Smokers are at a higher risk of developing TCC. It is more common in males -TCC(3:1). They usually present with painless gross hematuria. Thus the best investigation is urine microscopy and cytology for RBC's and malignant cells.
Other investigations for TCC include IVU, cystoscopy, biopsy/resection, USG abdomen to see bladder wall, pelvis, liver, lymph nodes, CT scan, MRI abdomen.
We can also suspect renal cell carcinoma which presents with haematuria and pain; more common in males and in smokers, for which urine microscopy is done for RBC's
Urine microscopy and cytology
X-ray KUB
Ultrasound KUB
DTPA scan