Gross hematuria is a symptom that frequently occurs unexpectedly. The practitionner should keep in mind that hematuria, particularly in the adult, should be considered as a symptom of malignancy until proven otherwise. This means that any patient presenting with this symptom should undergo complete urologic evaluation. Multidetector computerized tomography urography and cystoscopy are the most important modalities to determine the origin of hematuria. Flexible ureteroscopy can be useful for complete exploration of the upper urinary tract when the etiology remained unexplained. The purpose of this article is to propose a reliable systematic approach based on available techniques.