Seventy nine consecutive adult patients who presented at the Lagos University Teaching Hospital between February 2006 and January 2007 with gross haematuria were prospectively studied to determine the common causes of the haematuria and the prevalence of urological cancers among them. Sixty of the patients (75.9%) were males while 19 (24.1%) were females with a male to female ratio of 3.2: 1. The age range of these patients was 17 to 90 years, their mean age was 54.4 years and the peak age incidence was in the seventh decade of life. The leading causes of macroscopic haematuria in these patients were benign prostatic hyperplasia (30.4%), bladder carcinoma (12.7 %) and carcinoma of the prostate (10.1%). The prevalence of urological malignancies (29.1%) was high among the patients with macroscopic haematuria. The incidence of malignancies was strongly related to age and sex of the patients with higher prevalence in males and patients older than 50 years. Therefore, the investigation of macroscopic haematuria especially in older patients must be given a top priority. Improved patient education, prompt referral by general practitioners and increase in the capacity of urological/haematuria clinics will improve rapid diagnosis and treatment outcomes