This retrospective study evaluated the etiology, workup, and management of gross hematuria in 21 patients who underwent radical cystectomy (RC) and orthotopic neobladder (ONB) urinary diversion between 2017 and 2021 and later required cystoscopy for gross hematuria.
Nearly 1 in 4 patients (23.8%, n=5) had cancer recurrence as the cause—4 urethral and 1 upper tract—with a median time from cystectomy to hematuria of 29 months (IQR 15–36). Other causes included pouchitis (23.8%), anticoagulation-related bleeding (9.5%), and undetermined etiology in 42.9% despite full workup.
Very small cohort (n=21) from a single center limits generalizability. Nearly 43% of cases had no identified cause, suggesting diagnostic gaps. Retrospective design introduces potential selection and ascertainment bias.
Gross hematuria after radical cystectomy with orthotopic neobladder should prompt thorough evaluation—including cystoscopy and upper tract imaging—since cancer recurrence accounts for roughly 1 in 4 cases. Do not attribute hematuria to benign causes without ruling out recurrence, especially within the first 3 years post-cystectomy.
