A 55 Yr old smoker presents with history of 5 episodes of macroscopic hematuria each lasting for about 4-5 days in the past 5 yrs. Which of the following investigations should be performed to evaluate the suspected cause
**Core Concept**
The patient's presentation of recurrent macroscopic hematuria, a symptom of intermittent gross blood in the urine, requires a thorough evaluation to identify the underlying cause. This symptom can be associated with various conditions, including urinary tract infections, kidney stones, tumors, or vascular abnormalities.
**Why the Correct Answer is Right**
Macroscopic hematuria in a smoker, particularly with a history of recurrent episodes, raises suspicion for urothelial carcinoma, a type of cancer that arises from the epithelial lining of the urinary system. The correct investigation to evaluate this suspected cause is a **Voided Urine Cytology (VUC)**. This test involves examining the urine for abnormal cells, which can be indicative of cancer. The presence of atypical cells or malignant cells in the urine would support the suspicion of urothelial carcinoma.
**Why Each Wrong Option is Incorrect**
**Option A:** Ultrasonography is a useful tool for evaluating kidney structure and detecting abnormalities such as kidney stones or tumors, but it is not the primary investigation for suspected urothelial carcinoma.
**Option B:** Computed Tomography (CT) urography is a more detailed imaging technique that provides a comprehensive view of the urinary system, including the kidneys, ureters, and bladder. While it can help identify tumors or other abnormalities, it is not the first-line investigation for suspected urothelial carcinoma.
**Option C:** Invasive procedures such as cystoscopy may be necessary for further evaluation or diagnosis, but they are not the initial investigation for suspected urothelial carcinoma.
**Clinical Pearl / High-Yield Fact**
Remember that recurrent macroscopic hematuria in a smoker should prompt a thorough evaluation for urothelial carcinoma, and a voided urine cytology should be performed as the initial investigation.