@AnKing-Maintainers User has a point. If anything, AMBOSS’s wording (“Confirm the diagnosis with imaging and direct visualization of the urinary tract”) suggests that the likely next step would be imaging, followed by cystoscopy.
UW QID check?
#AK_Step2_v12::#UWorld::Step::16046 - pt presents with sxs concerning for bladder cancer, has “abdominal imaging” which shows unilateral hydronephrosis, asks for next step, answer is cystoscopy. In explanation, “The gold standard initial test is urinary cystoscopy which allows direct visualization and biopsy.” So this doesn’t explicitly answer our question since the question stem provides imaging.
Unable to check these:
#AK_Step2_v12::#UWorld::Step::8929
#AK_Step2_v12::#UWorld::Step::3335
#AK_Step2_v12::#UWorld::Step::16045
#AK_Step3_v12::#UWorld::5166
#AK_Step2_v12::#UWorld::COMLEX::103186
#AK_Step2_v12::#UWorld::COMLEX::101853
#AK_Step2_v12::#UWorld::COMLEX::103185
#AK_Step2_v12::#UWorld::COMLEX::100141
FA Step 2 11e says " Cystoscopy with biopsy is diagnostic and is recommended in the evaluation of adults >35 years of age with unexplained hematuria. MRI, CT, and bone scan are important tools with which to define muscle invasion and metastases." FA24 Step 1 doesn’t seem to have anything about this.
AMBOSS page that we’re referencing also says “Evaluate the entire urinary tract if malignancy is suspected. Use imaging to assess the renal pelvis and ureters and perform cystoscopy to assess the bladder and urethra.” in another section (https://next.amboss.com/us/article/6i0jsf#Yf11e6c0e5a16acf4bcc3066a27e0b6d0).
We could add something to the card’s stem about the pt already having had imaging done or something 
?
Perfect idea @andrewmathias8
“Physical exam, including rectal exam, and imaging are unremarkable”?
@AnKing-Maintainers Suggestion has been updated. I confirmed with OpenEvidence that cystoscopy is indicated in this scenario even if imaging and PE are unremarkable, since I couldn’t find anything specific in AMBOSS, and UW explanations weren’t elucidative:
Good to push?