A 64-year-old woman is referred to the emergency department because of a recent event of painless macroscopic hematuria . She reports having experienced several similar episodes during the past year, all of which spontaneously resolved. She is 5 years postmenopausal. She describes a general feeling of malaise in the days preceding the current episode but denies having any fever, dysuria, or increased frequency or urgency of urination. The patient also describes an unintentional weight loss of 5 kg during the past 1.5 years.
Physical examination VSS Head and neck examination findings are normal. Lung auscultation is normal and heart sounds are regular The abdomen is nondistended and nontender, no masses are palpated, and no signs of peritoneal irritation are present. No peripheral edema is noticed, peripheral pulses are palpated. A gynecologic evaluation that includes a speculum…
