OBJECTIVE. In this article, we will discuss the current status of imaging in patients with hematuria of urologic origin. Issues impacting evaluation of these patients with radiography, excretory urography, retrograde pyelography, and sonography will be discussed.CONCLUSION. Conventional radiography has no role in the detection of renal or urothelial carcinoma. Low-dose CT offers much greater sensitivities for the detection of urinary tract calculi than radiography at doses equivalent to conventional radiography. Ultrasound alone is insufficient for imaging of hematuria. Using ultrasound alone, it is often difficult to differentiate renal transitional cell carcinoma from other causes of filling defects of the renal collecting system such as blood clots, sloughed papillae, or fungus balls. The prominence of the role of excretory urography in the evaluation of patients with hematuria has diminished, and MDCT urography is now preferred to excretory urography in most cases.