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Painless Hematuria in the Older Adult Requires Cystoscopy if CT Urogram Fails to Provide a Definitive Source

By John Joseph Pack MD

Published on 05/10/2026

Painless, gross hematuria, in an adult 35 years or older, especially in a smoker, is a urologic malignancy until proven otherwise. The patient should undergo upper urinary tract imaging, with CT urogram of the kidneys, ureters, and urinary bladder, followed by cystoscopy, if no definite source is isolated from the CT scan. CT alone is not reliable to rule out a Bladder Cancer. Renal ultrasound is a lesser alternative to CT.

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