Assessment of visible haematuria

Normal PSA does not exclude possibility of prostate cancer.

Volumetric assessment of the prostate can be made from measurements of the length, width, and height of the prostate from transverse and sagittal views.

Urine flow meters are standard practice in many urological clinics. Post-void residuals can be measured by straight catheterisation or bladder ultrasound. Bladder ultrasonography is less invasive and a more reliable measure of bladder volume.

The presence of leukocyte esterase has a 50% positive predictive value and a 92% negative predictive value. The sensitivity of urinary nitrate is 35% to 85%, with false-negatives occurring in the setting of diuretic use, or infection with gram-positive organisms or Pseudomonas.[54]Pappas PG. Laboratory in the diagnosis and management of urinary tract infections. Med Clin North Am. 1991 Mar;75(2):313-25. http://www.ncbi.nlm.nih.gov/pubmed/1996036?tool=bestpractice.com

Clean-catch or catheterised specimen should be obtained before the initiation of treatment.

The presence of leukocyte esterase has a 50% positive predictive value and a 92% negative predictive value. The sensitivity of urinary nitrate is 35% to 85%, with false-negatives occurring in the setting of diuretic use, or infection with gram-positive organisms or Pseudomonas.[54]Pappas PG. Laboratory in the diagnosis and management of urinary tract infections. Med Clin North Am. 1991 Mar;75(2):313-25. http://www.ncbi.nlm.nih.gov/pubmed/1996036?tool=bestpractice.com

Clean-catch or catheterised specimen should be obtained before the initiation of treatment.

About 80% of patients present with visible or non-visible haematuria.[9]Powles T, Bellmunt J, Comperat E, et al. Bladder cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Mar;33(3):244-58. https://www.doi.org/10.1016/j.annonc.2021.11.012 http://www.ncbi.nlm.nih.gov/pubmed/34861372?tool=bestpractice.com  Pyuria may also be seen, resulting in confusion with urinary infection.

Cytological examination of voided urine (overall diagnostic accuracy of 49%) has a lower accuracy than cytology performed on bladder washings during cystoscopy (overall diagnostic accuracy of 66%). The sensitivity is poor for low-grade cancers compared with high-grade cancers and carcinoma in situ.[55]Maier U, Simak R, Neuhold N. The clinical value of urinary cytology: 12 years of experience with 615 patients. J Clin Pathol. 1995 Apr;48(4):314-7. http://www.ncbi.nlm.nih.gov/pubmed/7615848?tool=bestpractice.com Freshly preserved urine from the second or subsequent void is best to prevent cellular decay.

Two per cent of patients with bladder tumour have a coincident upper tract tumour.[36]Grossfeld GD, Litwin MS, Wolf JS, et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy - part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology. 2001 Apr;57(4):604-10. http://www.ncbi.nlm.nih.gov/pubmed/11306357?tool=bestpractice.com

Performed in the urology clinic with local analgesia. [Figure caption and citation for the preceding image starts]: Bladder tumour visible on cystoscopyHudson M, Catalona W, Gillenwater JY, et al, eds. Adult and pediatric urology. 3rd ed. St Louis, MO: Mosby;1996:1379-1464 [Citation ends].Endoscopic resection provides pathological diagnosis and primary treatment in one step.

A normal PSA value ranges from 0-4 micrograms/L (0-4 nanograms/mL); however, the upper level of normal may vary according to age and race. For example, many urologists recommend biopsies for a man in his 40s or 50s who presents with a PSA between 2 and 4.

Results reported on 5-point Likert scale. Likert score 3 or higher predicts clinically significant prostate cancer.[57]Harada T, Abe T, Kato F, et al. Five-point Likert scaling on MRI predicts clinically significant prostate carcinoma. BMC Urol. 2015 Sep 4;15:91. https://bmcurol.biomedcentral.com/articles/10.1186/s12894-015-0087-5 http://www.ncbi.nlm.nih.gov/pubmed/26334874?tool=bestpractice.com

NCCT is the preferred imaging modality for nephrolithiasis due to its high sensitivity and specificity, and should be ordered as soon as nephrolithiasis is suspected.

Provides information on chemical composition and aetiology.

If urinary calculi are detected on a non-contrast CT, a plain KUB radiograph of the abdomen should be performed to note the position and radiodensity of the stones for future follow-up. Often, a CT scout (topogram) is performed at the time of CTU, which can serve this purpose.

Contrast-enhanced CT is the best modality for the staging of renal injuries. Renal injuries are classified from grade I to grade V. Grade I is haematuria associated with contusion or contained subcapsular haematoma. Grade II injuries include renal cortical laceration <1 cm deep. Grade III injury is a renal parenchymal laceration >1 cm. Grade IV injuries include lacerations >1 cm extending into the collecting system or involve segmental renal vessels. Grade V injuries include laceration or avulsion of the main renal vessels, and major multiple lacerations.

Haemodynamically unstable patients that are taken to the operating room should undergo 'one-shot' IVP at the time of laparotomy. This can be used to exclude life-threatening renal injury and confirm the existence of a contralateral functioning kidney.[58]Morey AF, McAninch JW, Tiller BK, et al. Single shot intraoperative excretory urography for the immediate evaluation of renal trauma. J Urol. 1999 Apr;161(4):1088-92. http://www.ncbi.nlm.nih.gov/pubmed/10081844?tool=bestpractice.com

Urethral catheter is passed after urethral injury is ruled out. The bladder is filled with diluted contrast medium.[59]American College of Radiology. ACR appropriateness criteria: penetrating trauma – lower abdomen and pelvis. 2019 [internet publication]. https://acsearch.acr.org/docs/69376/Narrative

X-ray of the pelvis is indicated in cases of acute blunt lower abdominal or pelvic trauma, and should be performed in cases of penetrating trauma if the presence of a foreign body (e.g., a bullet) is suspected.[59]American College of Radiology. ACR appropriateness criteria: penetrating trauma – lower abdomen and pelvis. 2019 [internet publication]. https://acsearch.acr.org/docs/69376/Narrative

A retrograde urethrogram should be performed before placement of a urethral catheter. Patients with penetrating trauma to the penis should undergo fluoroscopy retrograde urethrography as the primary diagnostic procedure.[59]American College of Radiology. ACR appropriateness criteria: penetrating trauma – lower abdomen and pelvis. 2019 [internet publication]. https://acsearch.acr.org/docs/69376/Narrative

X-ray of the pelvis should be performed to determine if a pelvic fracture or diastasis of the pubic symphysis has occurred. This procedure can be combined with retrograde urethrography.[59]American College of Radiology. ACR appropriateness criteria: penetrating trauma – lower abdomen and pelvis. 2019 [internet publication]. https://acsearch.acr.org/docs/69376/Narrative

Cystoscopy can be performed to assess the degree of urethral disruption and to place an aligning catheter across the defect.

Electrophoresis differentiates patients who are homozygous from those who are heterozygous. A homozygous patient will have haemoglobin SS (HbSS, 80% to 90%), haemoglobin F (HbF, 2% to 20%), and haemoglobin A2 (HbA2, 2% to 4%). A carrier patient will have HbSS (35% to 40%) and haemoglobin A (HbA, 60% to 65%).

Thrombocytopenia may occur in idiopathic thrombocytopenic purpura and thrombotic thrombocytopenic purpura.

Hepatic dysfunction impairs production of clotting factors.

Von Willebrand's disease is a common inherited coagulopathy.

Renal cysts are well characterised by ultrasound. Structural features such as calcification or septation, often graded under the Bosniak classification system, may warrant further characterisation by other studies, such as CT.

Creatinine may be raised in cases of polycystic kidney disease.

Doppler ultrasound may demonstrate peaked, abruptly decreasing systolic frequency shifts in the renal artery and proximal segmental branches. Venous signal may be absent or show flow turbulence in narrowed sections of the renal vein.

Although inferior vena cavography and selective catheterisation of the renal vein is the gold standard of diagnosis, non-invasive modalities are employed first.

Proteinuria is usually present to some degree with Alport syndrome and can be severe in up to one third of patients. A nephrology consult should be obtained. In patients in whom renal failure, heavy proteinuria (>3 g/day), or severe hypertension is present, a nephrology consult should be obtained immediately, as prompt treatment or a renal biopsy may be necessary.

Microscopy should be performed on specimens collected from sites of suspected extrapulmonary TB.​[61]Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):e1-33. https://academic.oup.com/cid/article/64/2/e1/2629583?login=false http://www.ncbi.nlm.nih.gov/pubmed/27932390?tool=bestpractice.com [62]Nataraj G, Kurup S, Pandit A, et al. Correlation of fine needle aspiration cytology, smear and culture in tuberculous lymphadenitis: a prospective study. J Postgrad Med. 2002 Apr-Jun;48(2):113-6. https://www.jpgmonline.com/article.asp?issn=0022-3859;year=2002;volume=48;issue=2;spage=113;epage=6;aulast=Nataraj http://www.ncbi.nlm.nih.gov/pubmed/12215692?tool=bestpractice.com

Patients in whom urogenital TB is suspected should have three early morning urines on consecutive days sent for acid-fast bacilli microscopy and culture​​.[63]Muneer A, Macrae B, Krishnamoorthy S, et al. Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol. 2019 Oct;16(10):573-98. https://www.nature.com/articles/s41585-019-0228-9 http://www.ncbi.nlm.nih.gov/pubmed/31548730?tool=bestpractice.com ​​ Culture result may take several weeks.

Evidence of unrecognised pulmonary TB or evidence of old healed TB (e.g., upper lobe fibrosis) may be present; such abnormalities should prompt sputum collection for smear, culture, and nucleic acid amplification testing.

Testing of 3 specimens (minimum 8 hours apart, including an early morning specimen) is recommended in many countries; consult local guidance.​[61]Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):e1-33. https://academic.oup.com/cid/article/64/2/e1/2629583?login=false http://www.ncbi.nlm.nih.gov/pubmed/27932390?tool=bestpractice.com

Sputum specimen should be tested in patients with suspected extrapulmonary TB, as active pulmonary TB is seen in 15% to 20% of patients with extrapulmonary TB.[64]Geldmacher H, Taube C, Kroeger C, et al. Assessment of lymph node tuberculosis in northern Germany: a clinical review. Chest. 2002 Apr;121(4):1177-82. http://www.ncbi.nlm.nih.gov/pubmed/11948050?tool=bestpractice.com [65]Weir MR, Thornton GF. Extrapulmonary tuberculosis. Experience of a community hospital and review of the literature. Am J Med. 1985 Oct;79(4):467-78. http://www.ncbi.nlm.nih.gov/pubmed/4050833?tool=bestpractice.com [66]Baydur A. The spectrum of extrapulmonary tuberculosis. West J Med. 1977 Apr;126(4):253-62. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1237539/pdf/westjmed00272-0024.pdf http://www.ncbi.nlm.nih.gov/pubmed/855317?tool=bestpractice.com ​​​

Culture of Mycobacterium tuberculosis typically takes several weeks (up to 8 weeks), decisions on treatment are usually made before culture results are known.​

Although NAATs were originally designed and approved for respiratory specimens, they may also be requested on specimens from other sites where involvement of TB is suspected (e.g., cerebrospinal fluid, lymph node aspirate, lymph node biopsy, pleural fluid, peritoneal fluid, pericardial fluid, synovial fluid or urine).[61]Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):e1-33. https://academic.oup.com/cid/article/64/2/e1/2629583?login=false http://www.ncbi.nlm.nih.gov/pubmed/27932390?tool=bestpractice.com [67]World Health Organization. WHO consolidated guidelines on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection. Mar 2024 [internet publication].​ https://www.who.int/publications/i/item/9789240089488 ​​​​​ In the US, use of NAATs for extrapulmonary specimens is not approved by the Food and Drug Administration, and use would be off-label.

Several rapid NAATs are available for the diagnosis of TB and some are also able to detect genes encoding resistance to TB drugs.[67]World Health Organization. WHO consolidated guidelines on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection. Mar 2024 [internet publication].​ https://www.who.int/publications/i/item/9789240089488 ​​

One Cochrane review found the lateral flow urine lipoarabinomannan (LF-LAM) assay to have a sensitivity of 42% in diagnosing TB in HIV-positive individuals with TB symptoms, and 35% in HIV-positive individuals not assessed for TB symptoms.[68]Bjerrum S, Schiller I, Dendukuri N, et al. Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in people living with HIV. Cochrane Database Syst Rev. 2019 Oct 21;10(10):CD011420. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011420.pub3/full http://www.ncbi.nlm.nih.gov/pubmed/31633805?tool=bestpractice.com [ ] What is the accuracy of lateral flow urine lipoarabinomannan (LF‐LAM) for detecting tuberculosis (TB) in symptomatic HIV‐positive adults?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2824/fullShow me the answer [ ] What is the accuracy of lateral flow urine lipoarabinomannan (LF‐LAM) for detecting tuberculosis (TB) in unselected HIV‐positive adults (symptomatic or asymptomatic)?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2825/fullShow me the answer​​​​ WHO recommends that LF-LAM can be used to assist in the diagnosis of active TB in HIV-positive adults, adolescents, and children with signs and symptoms of TB, or in those with advanced HIV or who are seriously ill.[67]World Health Organization. WHO consolidated guidelines on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection. Mar 2024 [internet publication].​ https://www.who.int/publications/i/item/9789240089488

Culture would still be required for drug susceptibility testing (DST).

Medical renal diseases, suggested by the presence of dysmorphic red cells, proteinuria, and cellular casts, require referral to a nephrologist for further laboratory testing and imaging. In patients in whom renal failure, heavy proteinuria (>3 g/day), or severe hypertension is present, a nephrology consultation should be obtained immediately, as prompt treatment or a renal biopsy may be necessary.

Because this is a benign condition generally diagnosed through history alone, a renal biopsy is not indicated unless there is refractory hypertension or renal failure. The need for biopsy should be assessed by a nephrologist, and is generally performed in the setting of refractory hypertension, heavy proteinuria, or renal failure.

Medical renal diseases, suggested by the presence of dysmorphic red cells, proteinuria, and cellular casts, require referral to a nephrologist for further laboratory testing and imaging. In patients in whom renal failure, heavy proteinuria (>3 g/day), or severe hypertension is present, a nephrology consult should be obtained immediately.

Medical renal diseases, suggested by the presence of dysmorphic red cells, proteinuria, and cellular casts, require referral to a nephrologist for further laboratory testing and imaging. In patients in whom renal failure, heavy proteinuria (>3 g/day), or severe hypertension is present, a nephrology consult should be obtained immediately, as prompt treatment or a renal biopsy may be necessary.

Multiple complement components may be depressed. Nephrological consultation is necessary to perform a comprehensive work-up, which may include a renal biopsy.

The need for biopsy should be assessed by a nephrologist.

Medical renal diseases, suggested by the presence of dysmorphic red cells, proteinuria, and cellular casts, require referral to a nephrologist for further laboratory testing and imaging. Suspicion of a rapidly progressive glomerulonephritis requires immediate nephrology consult with further serologies and renal biopsy.

The need for biopsy should be assessed by a nephrologist.

Medical renal diseases, suggested by the presence of dysmorphic red cells, proteinuria, and cellular casts, require referral to a nephrologist for further laboratory testing and imaging. In patients in whom renal failure, heavy proteinuria (>3 g/day), or severe hypertension is present, a nephrology consult should be obtained immediately, as prompt treatment or a renal biopsy may be necessary.

Medical renal diseases, suggested by the presence of dysmorphic red cells, proteinuria, and cellular casts, require referral to a nephrologist for further laboratory testing and imaging. In patients in whom renal failure, heavy proteinuria (>3 g/day), or severe hypertension is present, a nephrology consult should be obtained immediately, as prompt treatment or a renal biopsy may be necessary.

To be considered in anyone suspected of having SLE.

All patients presenting with cardiopulmonary symptoms should have a chest x-ray performed.

All patients presenting with cardiopulmonary symptoms should have an ECG performed.

Detection of masses <2 cm is poor.[69]Warshauer DM, McCarthy SM, Street L, et al. Detection of renal masses: sensitivities and specificities of excretory urography/linear tomography, US, and CT. Radiology. 1988 Nov;169(2):363-5. http://www.ncbi.nlm.nih.gov/pubmed/3051112?tool=bestpractice.com  Overall detection rate for renal cell carcinoma is as low as 71% with conventional ultrasound, whereas contrast-enhanced ultrasound (CEUS) may be much more accurate (100% diagnostic rate in one study).[70]Dong XQ, Shen Y, Xu LW, et al. Contrast-enhanced ultrasound for detection and diagnosis of renal clear cell carcinoma. Chin Med J (Engl). 2009 May 20;122(10):1179-83. http://www.ncbi.nlm.nih.gov/pubmed/19493467?tool=bestpractice.com  Ultrasound is inferior to CT and MRI for tumour staging (especially local invasion/extension).[71]Heidenreich A, Ravery V; European Society of Oncological Urology. Preoperative imaging in renal cell cancer. World J Urol. 2004 Nov;22(5):307-15. http://www.ncbi.nlm.nih.gov/pubmed/15290202?tool=bestpractice.com  If clinical presentation or ultrasound findings are suspicious for renal cell carcinoma, CT imaging is essential.

Definitive test for diagnosis and staging of renal cell carcinoma. Contrast-enhanced CT with renal protocol has been found to have 100% specificity and ≥90% sensitivity for characterising a renal mass as malignant.[71]Heidenreich A, Ravery V; European Society of Oncological Urology. Preoperative imaging in renal cell cancer. World J Urol. 2004 Nov;22(5):307-15. http://www.ncbi.nlm.nih.gov/pubmed/15290202?tool=bestpractice.com  There is evidence to suggest that the overall accuracy of tumour extent on CT is 93% specific and 96% sensitive when compared with final pathological staging; accuracy is 99% specific for adrenal involvement but with variable positive predictive values (35% to 93%); there is a 10% false-negative rate and a 58% false-positive rate for lymph node assessment.[71]Heidenreich A, Ravery V; European Society of Oncological Urology. Preoperative imaging in renal cell cancer. World J Urol. 2004 Nov;22(5):307-15. http://www.ncbi.nlm.nih.gov/pubmed/15290202?tool=bestpractice.com

85% of solid renal masses that enhance are renal cell carcinomas. Other findings may include displacement and distortion of the renal collecting system or aberrant vasculature surrounding the mass.[11]Tanagho EA, McAninch JW. Smith's general urology, 16th ed. New York, NY: McGraw-Hill; 2003.[Figure caption and citation for the preceding image starts]: CT of renal cell carcinoma (RCC) of the left kidneyFrom the personal collection of Dr Reese [Citation ends].

Modality of choice for diagnosis and staging in patients where contrast dye is contraindicated (due to renal insufficiency or allergy). Can be used as an adjunct to CT to better assess adrenal invasion and vena cava involvement by tumour or thrombus (found to be 94% accurate for thrombus).[71]Heidenreich A, Ravery V; European Society of Oncological Urology. Preoperative imaging in renal cell cancer. World J Urol. 2004 Nov;22(5):307-15. http://www.ncbi.nlm.nih.gov/pubmed/15290202?tool=bestpractice.com  MRI may be more useful than CT in assessing potential benign lesions such as angiomyolipoma.[72]Silverman SG, Israel GM, Herts BR, et al. Management of the incidental renal mass. Radiology. 2008 Oct;249(1):16-31. http://www.ncbi.nlm.nih.gov/pubmed/18796665?tool=bestpractice.com

Especially recommended before treatment with ablative therapy and in patients with metastatic disease, before starting systemic treatment.[52]Escudier B, Porta C, Schmidinger M, et al. Renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019 May 1;30(5):706-20. https://www.esmo.org/guidelines/genitourinary-cancers/renal-cell-carcinoma http://www.ncbi.nlm.nih.gov/pubmed/30788497?tool=bestpractice.com

Definitive test for diagnosis and staging of renal cell carcinoma. Contrast-enhanced CT with renal protocol has been found to have 100% specificity and ≥90% sensitivity for characterising a renal mass as malignant.[71]Heidenreich A, Ravery V; European Society of Oncological Urology. Preoperative imaging in renal cell cancer. World J Urol. 2004 Nov;22(5):307-15. http://www.ncbi.nlm.nih.gov/pubmed/15290202?tool=bestpractice.com  There is evidence to suggest that the overall accuracy of tumour extent on CT is 93% specific and 96% sensitive when compared with final pathological staging; accuracy is 99% specific for adrenal involvement but with variable positive predictive values (35% to 93%); there is a 10% false-negative rate and a 58% false-positive rate for lymph node assessment.[71]Heidenreich A, Ravery V; European Society of Oncological Urology. Preoperative imaging in renal cell cancer. World J Urol. 2004 Nov;22(5):307-15. http://www.ncbi.nlm.nih.gov/pubmed/15290202?tool=bestpractice.com

Modality of choice for diagnosis and staging in patients where contrast dye is contraindicated (due to renal insufficiency or allergy). Can be used as an adjunct to CT to better assess adrenal invasion and vena cava involvement by tumour or thrombus (found to be 94% accurate for thrombus).[71]Heidenreich A, Ravery V; European Society of Oncological Urology. Preoperative imaging in renal cell cancer. World J Urol. 2004 Nov;22(5):307-15. http://www.ncbi.nlm.nih.gov/pubmed/15290202?tool=bestpractice.com  MRI may be more useful than CT in assessing potential benign lesions such as angiomyolipoma.[72]Silverman SG, Israel GM, Herts BR, et al. Management of the incidental renal mass. Radiology. 2008 Oct;249(1):16-31. http://www.ncbi.nlm.nih.gov/pubmed/18796665?tool=bestpractice.com

Useful in evaluating strictures, fistulas, diverticula, and neoplasms.

Indicated in cases of visible haematuria.

Certain stones, such as magnesium-ammonium phosphate stones, are generally radiolucent and may be seen as a filling defect in the bladder or not visible on plain radiograph.

Insults to the kidney by nephrotoxic medications may present as medical renal disease and requires referral to a nephrologist for further laboratory testing and imaging.

Drug hypersensitivity results from interactions between a pharmacological agent and the human immune system.

Urinary tract bleeding (even in cases of supratherapeutic anticoagulation) often represents an exacerbation of an underlying disease process or urinary tract lesion[22]Bhatt NR, Davis NF, Nolan WJ, et al. Incidence of visible hematuria among antithrombotic agents: a systematic review of over 175,000 patients. Urology. 2018 Apr;114:27-32. http://www.ncbi.nlm.nih.gov/pubmed/29191640?tool=bestpractice.com

Urinary tract bleeding (even in cases of supratherapeutic anticoagulation) often represents an exacerbation of an underlying disease process or urinary tract lesion.[22]Bhatt NR, Davis NF, Nolan WJ, et al. Incidence of visible hematuria among antithrombotic agents: a systematic review of over 175,000 patients. Urology. 2018 Apr;114:27-32. http://www.ncbi.nlm.nih.gov/pubmed/29191640?tool=bestpractice.com

Urinary tract bleeding (even in cases of supratherapeutic anticoagulation) often represents an exacerbation of an underlying disease process or urinary tract lesion.[22]Bhatt NR, Davis NF, Nolan WJ, et al. Incidence of visible hematuria among antithrombotic agents: a systematic review of over 175,000 patients. Urology. 2018 Apr;114:27-32. http://www.ncbi.nlm.nih.gov/pubmed/29191640?tool=bestpractice.com