رجل عمره ٦٦ سنة يدخن منذ ٤٠ سنة، وعمل في مصنع أصباغ. لاحظ دماً في البول بدون ألم ٣ مرات خلال شهر. لا توجد حرارة أو حرقة، والمزرعة سلبية. ما الإجراء الأنسب؟

A 66-year-old man who has smoked for 40 years and worked in a dye factory has noticed painless blood in his urine three times in a month. There is no fever or dysuria and urine culture is negative. What is the most appropriate action?

1. Refer for cystoscopy to exclude bladder cancer
2. Reassure him it is due to heat and low water intake
3. Give antibiotics for a UTI and repeat the test
4. Drink cranberry juice daily and review in a year

Answer: A) Refer for cystoscopy to exclude bladder cancer. Painless haematuria in an older smoker is a red flag for bladder cancer; smoking and industrial chemicals are the main risk factors.