In primary care, the evaluation of haematuria to exclude urinary tract malignancy involves specific referral criteria based on patient age, haematuria type (visible or non-visible), and associated symptoms NICE NG12.
Visible haematuria that is unexplained or persists/recurs after UTI treatment in individuals aged 45 years and over warrants a suspected cancer pathway referral NICE NG12. In men, visible haematuria also prompts consideration of a prostate-specific antigen (PSA) test and digital rectal examination NICE NG12. For women aged 55 and over with visible haematuria, if accompanied by low haemoglobin levels, thrombocytosis, high blood glucose levels, or unexplained vaginal discharge, a direct access ultrasound scan should be considered NICE NG12.
Non-visible haematuria in individuals aged 60 years and over, when associated with dysuria or a raised white cell count, requires a suspected cancer pathway referral for bladder cancer NICE NG12.
For women, specific criteria also apply: visible haematuria without UTI, or haematuria that persists or recurs after UTI treatment, in those aged 45 years and over, necessitates a suspected cancer pathway referral for bladder cancer NICE CKS,NICE CKS. If a woman is aged 60 years and over and has unexplained non-visible haematuria with dysuria or a raised white cell count, a suspected cancer pathway referral is also indicated NICE CKS,NICE CKS.
If there is uncertainty about the cause of haematuria and no urgent referral is indicated, specialist advice should be sought regarding further assessment or referral to a urologist or renal physician NICE CKS.