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The presence of hematuria should be thought of as a red flag. A red flag which mandates careful evaluation to rule out serious and life-threatening underlying causes, although again, there are many benign causes of hematuria. Following the history and physical examination that includes a pelvic exam in females and a digital rectal examination of the prostate in males and urinalysis, the following tests will provide help in diagnosing the underlying problem: a urine culture to see if a urinary tract infection is present, urinary cytology, that essentially is a pap smear of urine cells that are sloughed off the lining of the bladder, ureters and kidney, imaging, that is fundamentally important that might include ultrasound, CT or MRI. And finally, and certainly not the least important test, a cystoscopy, which is a visual inspection of the bladder with a narrow, flexible instrument that can be done either under local or general anesthetic.
