Evaluation of hematuria.

A basic problem in evaluating hematuria is the large number of diagnostic possibilities. The causation may be suspected after the initial history and physical examination, and can be confirmed with appropriate studies. The addition of standard tests such as urine culture, intravenous pyelography, and cystoscopy will reveal the source of hematuria in many other cases and will bring the percentage of patients with a clear diagnosis up to 60 or 70 per cent. The physician must be careful in selecting further studies in the remaining patients, since the procedures necessary for diagnosis may be expensive, unpleasant, and potentially harmful, and the probability of finding a treatable condition is low. The diagnostic protocol described in this article is designed to reduce the studies performed to a minimum, while still identifying those individuals who can benefit from therapy.