Question:medium
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 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?
Show Hint
Painless recurrent hematuria with clots in an older male means malignancy; pick the test that detects cells.
Updated On: Jun 24, 2026
- Urine examination and microscopy
- X-ray KUB
- Abdominal USG
- DTPA scan
Show Solution
The Correct Option is A
Solution and Explanation
This scenario describes an older man with repeated bouts of painless bleeding in the urine accompanied by clots over several years, a classic alarm pattern that points to a tumour of the urinary tract, most commonly bladder urothelial carcinoma. When deciding the best investigation, weigh what each test contributes to actually reaching a diagnosis. Urine analysis with microscopy and cytology confirms the hematuria objectively and can detect shed malignant cells from the urothelium, directly supporting the suspected diagnosis, so it is the most informative first-line test among those offered. By contrast, a plain KUB radiograph chiefly detects calcified stones and would miss a soft-tissue tumour; abdominal ultrasonography is a useful screen but is operator-dependent and may overlook small mucosal bladder lesions; and a DTPA renogram only measures kidney perfusion and excretion, which is irrelevant to identifying the bleeding source. The definitive test in real practice is cystoscopy, but from the given list urine examination with microscopy is the correct best choice.\[\boxed{\text{Urine examination and microscopy}}\]
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