A 65-year-old man with diabetes and obesity on pioglitazone presents with dysuria, polyuria, and frank haematuria. What is the most appropriate reason for him to see his GP?

• A. Urinary tract infection
• B. Side effect of pioglitazone – MHRA warning for bladder cancer – haematuria
• C. Benign prostatic hyperplasia
• D. Worsening glycemic control

Answer: (B)

The key idea is recognizing a drug safety warning tied to this medication. Pioglitazone has been associated with an increased risk of bladder cancer, and regulatory bodies advise vigilance for urinary symptoms, especially haematuria. In a patient on pioglitazone who develops dysuria and visible blood in the urine, this haematuria is a red flag for potential bladder pathology rather than a routine infection or simple age-related prostatic changes. Because of the known risk, the most appropriate reason to see the GP is to investigate for bladder cancer related to pioglitazone and to review this medication in light of the findings. While urinary tract infection, benign prostatic hyperplasia, or glycemic control could explain some symptoms, the drug-related cancer risk makes urgent evaluation the priority.