A 50-year-old male smoker presents with hematuria; what should be the next step in management?

In the case of a 50-year-old male smoker presenting with hematuria, the appropriate next step in management involves obtaining a urinalysis and referring the patient for urology evaluation. Hematuria can be indicative of various underlying conditions, including urinary tract infections, kidney stones, or malignancies, especially in this patient demographic where risk factors like smoking heighten the suspicion for conditions such as bladder cancer or renal cancer.

A urinalysis is vital as it can confirm the presence of blood and assess for any associated abnormalities, such as infection indicators or evidence of glomerular disease. Following the urinalysis, referring to a urologist ensures that the patient undergoes further evaluation, which typically includes imaging studies such as a CT scan and perhaps a cystoscopy, particularly if there are signs suggestive of malignancy.

Immediate cystoscopy might seem appropriate in certain scenarios of gross hematuria; however, it is generally not the first-line approach without the preliminary assessment. The urgency of a CT scan can also be warranted, but usually follows the initial urinalysis and urology consultation, as it is performed to identify potential anatomical causes or tumors rather than as a first step in management. Starting antibiotics would not address the potential underlying causes effectively