A 60 yr old smoker came with a history of painless gross hematuria for one day. Which would be the most logical investigation to be done in this patient?
The above history gives us a suspicion of urothelial carcinomas. Gross, painless hematuria in older adults is considered a urinary tract cancer until proven otherwisw. Among the options provided, urine microscopy for malignant cytology is the the best investigation of choice after hematuria has been documented, to rule out carcinoma. Routine urine microscopy and plain Xray KUB will not give desired information to rule out urothelial carcinoma. Ref: Harrison's Principles of Internal Medicine,16th Edition, page 539; In a Page Signs & Symptoms By Scott Kahan, 2ndEdition, Page 140.
USG KUB
Urine routine
Plain X ray KUB
Urine microscopy for malignant cytology