Haematuria ( Frank ) in men : Triage

Visible (macroscopic) hematuria, documented since ancient times, is particularly alarming when there is no preceding event, such as trauma, cystitis-related dysuria, or kidney stone passage, to explain its occurrence. In contrast, nonvisible (microscopic) hematuria, or microhematuria, may remain undetected for extended periods and is often discovered incidentally during urinalysis for other reasons.

The presence of frank hematuria in men, especially the elderly, raises significant clinical concern due to the potential underlying causes, which range from benign conditions such as urinary tract infections or kidney stones to more serious pathologies like malignancies of the urinary tract, including bladder or prostate cancer. Given the wide differential diagnosis, a thorough clinical assessment is essential to identify the underlying etiology and initiate appropriate management. This evaluation often includes a detailed history, physical examination, and diagnostic investigations, aiming to exclude life-threatening conditions and ensure timely intervention.

In some regions, such as northern Africa, where Schistosoma haematobium is endemic, microhematuria is common due to prevalent bladder infestations. The causes of hematuria also differ between men and women, necessitating gender-specific evaluation approaches. The implications of hematuria vary significantly depending on its etiology, with a critical aspect of evaluation being the exclusion of malignancy, given the association of...