Investigations

The investigations of choice in any patient with haematuria are:

• urinalysis - culture for bacteria, microscopy to confirm presence of red blood cells, and cytology for malignant cells. Urine cytology enables diagnosis and grading of the tumour in 60% of cases.
• intravenous urography - now rarely used
  • upper urinary tract tumours usually appear as filling defects in the renal pelvis or ureters. Rarely, the renal outline may be distorted. A bladder tumour may cause ureteric obstruction. An IVU will usually demonstrate a renal adenocarcinoma causing haematuria.
• ultrasound
• cystoscopy
• other useful investigations
  • full blood count, urea and electrolytes, creatinine
  • chest x-ray

Suggested investagtions if diagnosis of bladder cancer (1)

• consider CT or MRI staging before transurethral resection of bladder tumour (TURBT) if muscle-invasive bladder cancer is suspected at cystoscopy
  
  
• offer white-light-guided TURBT with one of photodynamic diagnosis, narrow-band imaging, cytology or a urinary biomarker test (such as UroVysion using fluorescence in-situ hybridization [FISH], ImmunoCyt or a nuclear matrix protein 22 [NMP22] test) to people with suspected bladder cancer. This should be carried out or supervised by a urologist experienced in TURBT
  
  
  • obtain detrusor muscle during TURBT
    
    
  • offer people with suspected bladder cancer a single dose of intravesical mitomycin C given at the same time as the first TURBT

Reference:

• 1) NICE (February 2015). Bladder cancer: diagnosis and management of bladder cancer