Hematuria: Urological Investigations: A Review

Alaa Al-Deen Al-Dabbagh, Haider Alaa Mohammed Ali and Kais Kassim Ghaima

Abstract

Hematuria is a common clinical manifestation with a wide range of causes, from benign, transient diseases to serious malignancies of the urinary system. Hematuria can be gross or microscopic, each with different diagnostic significance and risk assessment implications. While many causes are benign, including infection, urinary tract stones, and benign prostatic hyperplasia, hematuria can also be the earliest sign of urothelial carcinoma or kidney malignancies. Studies have shown that tumor detection rates are significantly higher in patients with gross hematuria than in those with microscopic hematuria. Therefore, a comprehensive clinical evaluation is crucial, including medical history, physical examination, laboratory tests, imaging studies, and cystoscopy. Urinalysis and urine culture help differentiate between glomerular and non-glomerular causes, while urine cytology can serve as an adjunct in high-risk cases. Imaging techniques such as ultrasound and CT urography play a central role in assessing upper urinary tract diseases. Cystoscopy remains the gold standard for examining the lower urinary tract. Existing guidelines, including those from the American Urological Association and the European Association of Urology, recommend a risk-adaptive diagnostic approach to optimize cancer screening and minimize unnecessary invasive procedures. This article reviews the etiology, classification, and evidence-based urological diagnosis of hematuria in clinical practice.