A 57-year-old man presents to his physician for his annual examination. He has a history of hypertension, chronic obstructive pulmonary disease (COPD), and benign prostatic hyperplasia (BPH). On examination, there is hyper-resonance to percussion of both lung fields and a diffusely enlarged, nontender prostate on rectal examination. His blood work is unremarkable, but urine studies show 12 RBCs per high power field. There are no dysmorphic RBCs or RBC casts, and there are no other cells or protein. He denies any fevers, flank or groin pain, episodes of gross hematuria, or dysuria. A repeat urinalysis 1 week later confirms the presence of microscopic hematuria, and his urine culture is negative. He elects to undergo further workup with a CT scan of the abdomen and pelvis with and without contrast, which is unremarkable. What is the next step in management?
Question
A 57-year-old man presents to his physician for his annual examination. He has a history of hypertension, chronic obstructive pulmonary disease (COPD), and benign prostatic hyperplasia (BPH). On examination, there is hyper-resonance to percussion of both lung fields and a diffusely enlarged, nontender prostate on rectal examination. His blood work is unremarkable, but urine studies show 12 RBCs per high power field. There are no dysmorphic RBCs or RBC casts, and there are no other cells or protein. He denies any fevers, flank or groin pain, episodes of gross hematuria, or dysuria. A repeat urinalysis 1 week later confirms the presence of microscopic hematuria, and his urine culture is negative. He elects to undergo further workup with a CT scan of the abdomen and pelvis with and without contrast, which is unremarkable. What is the next step in management?
Solution
The next step in management for this patient would be a cystoscopy. Given the patient's age, history of smoking (suggested by his COPD), and the presence of unexplained microscopic hematuria, bladder cancer needs to be ruled out. A cystoscopy allows for direct visualization of the bladder mucosa and urethra, which is necessary for the diagnosis of bladder cancer.
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