A 65-year-old male smoker presents with painless gross hematuria. Urinalysis confirms numerous intact RBCs without dysmorphic features or casts. What is the priority diagnostic investigation?
Answer and explanation
Correct answer: D. Cystoscopy and multiphasic CT urography
- Step 1: Painless macroscopic hematuria in an older adult smoker is urothelial carcinoma of the bladder or upper urinary tract until proven otherwise.
- Step 2: The standard diagnostic workup requires visualization of the bladder urothelium via flexible cystoscopy and imaging of the upper tract via CT urography.
- Step 3: Renal biopsy is indicated for intrinsic glomerulonephritis (dysmorphic RBCs and RBC casts), not for gross painless hematuria.
Answer
Cystoscopy and multiphasic CT urography.
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