For patients with non-visible haematuria, the probability of missing malignant disease with a guideline-based clinic protocol is less than 1% up to the age of 90. However, for visible haematuria the risk increases with age, and is greater than 4% by 70. This paper in the BJU follows up patients referred to the Plymouth haematuria clinic between 1998 and 2003. A total of 4,020 patients took part in the original study. All patients had a plain x-ray, renal tract ultrasound and flexible cystoscopy as part of their original investigation. Intravenous urography was also performed after abnormal first-line investigation or in patients with persistent haematuria at presentation where no abnormality had been detected. 'We must never assume that the haematuria clinic protocol for investigation is infallible, and for patients with visible haematuria it is important to repeat investigation if further episodes occur (or at least seek specialist advice). However, the study does not support the unselected use of additional upper tract imaging in all haematuria patients, but instead suggests that this should be targeted towards those over 50 with visible haematuria.'