Review Question - QID 104525

In patients over the age of 40, a bladder tumor is the most likely cause of the development of painless hematuria.

Transitional cell, squamous cell, and adenocarcinoma of the bladder are the 3 types of malignancies that can arise from the bladder. They often present in later stages with the patient having microscopic or gross hematuria. It is unlikely that a mass will be palpated, however abdominal pain and dysuria can be associated with a large mass. Smoking is associated with the development of transitional cell carcinoma. Treatment varies based on the extent of disease.

Thaler and Wang review the evaluation of asymptomatic hematuria in adults. Routine screening in adults is not warranted because of the intermittent occurrence of this finding. Microscopic hematuria associated with anticoagulation therapy is a concerning sign and must be evaluated further.

Jimbo discusses the management of hematuria from the perspective of a primary care physician. He places the importance on first determining whether the patient is experiencing true hematuria and then referring the patient to the correct specialty for further evaluation.

Illustration A is an image of a bladder tumor on cystoscopy. Illustration B is a flow chart depicting the standard work up of a patient with hematuria.

Incorrect Answers:
Answer 2: Renal cell carcinoma is the second most common cause of painless hematuria in this age group.
Answer 3: Consuming large quantities of beets can turn the urine red, but unlikely without a history of beet consumption.
Answer 4: Pain is usually associated with a urinary tract infection and it is unlikely to result in hematuria.
Answer 5: This patient has no history of a traumatic injury.