Question

A 55 year old man presents with a history of 5 episodes of hematuria, each lasting about 4 to 5 days and associated with clots, over the past 5 years. What is the best investigation to arrive at a diagnosis?

• A. Urine examination and microscopy
• B. X-ray KUB
• C. Abdominal USG
• D. DTPA scan

Hint:

Painless recurrent hematuria with clots in an older male means malignancy; pick the test that detects cells.

Answer 1

The Correct Option is A

Step 1: Interpret the clinical picture. Recurrent, painless gross hematuria with clots in an older male is highly suggestive of a urothelial (bladder) malignancy until proven otherwise.
Step 2: Choose the most useful investigation among the options. Urine examination with microscopy (including urine cytology) directly looks for red cells and malignant urothelial cells, providing diagnostic information about the bleeding and possible tumour. Among the choices given, it is the best initial investigation to work towards a diagnosis.
Step 3: Eliminate the other options. X-ray KUB mainly shows radio-opaque stones and gives little information on a bleeding tumour. Abdominal USG can show masses but is operator-dependent and less sensitive for small bladder lesions. A DTPA scan assesses differential renal function and drainage, not the cause of hematuria.
Step 4: Conclusion. Urine examination and microscopy (with cytology) is the best investigation among those listed; cystoscopy would be the definitive confirmatory test.