Urinary Tract Malignancy

Male hairdresser age >35 years with h/o chronic UTI, pelvic radiation, smoking, and NSAID analgesic abuse presents with asymptomatic hematuria. No pertinent positive on ROS. No abnormalities on physical exam.

• Obtain BMP

• Urinalysis shows gross hematuria

• Obtain CT to evaluate upper urinary tract

• Imaging

  • Refer to urology for cystoscopy

  • Cystoscopy negative with risk factors for malignancy: Obtain CT abdomen/pelvis with and without contrast

• Lesions suspicious for malignancy on imaging: Refer to oncology

• Pt counseled about risks of smoking, analgesic abuse

Notes

• Epidemiology

  • Responsible for 5% of asymptomatic hematuria cases

  • Occupational exposure to benzenes or aromatic amines (e.g. hairdressers) increases risk

• May present with gross or microscopic hematuria