Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
The criteria for referring a patient with haematuria for further urological assessment, particularly via a suspected cancer pathway (2-week wait), depend on the type of haematuria, the patient's age, and associated symptoms NICE CKS,NICE CKS,NICE CKS,NICE NG12.
- For Visible Haematuria:
- Refer people aged 45 years and over using a suspected cancer pathway referral if they have unexplained visible haematuria without a urinary tract infection (UTI) NICE CKS,NICE CKS,NICE NG12.
- Refer people aged 45 years and over using a suspected cancer pathway referral if they have visible haematuria that persists or recurs after successful treatment of a UTI NICE CKS,NICE CKS,NICE CKS,NICE NG12.
- In men, visible haematuria may prompt consideration of a prostate-specific antigen (PSA) test and digital rectal examination NICE NG12. If PSA levels are above the age-specific threshold along with visible haematuria or other lower urinary tract symptoms, consider a suspected cancer pathway referral for prostate cancer NICE NG12.
- For Non-Visible Haematuria:
- Refer people aged 60 years and over using a suspected cancer pathway referral if they have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test NICE CKS,NICE CKS,NICE CKS,NICE NG12.
- Specific Considerations for Women:
- If a pregnant woman has persistent haematuria after completing antibiotic treatment for a UTI, seek urgent specialist advice from an obstetrician regarding ongoing management NICE CKS.
- For women aged 60 years and over with recurrent or persistent unexplained UTIs, consider a non-urgent referral for bladder cancer NICE CKS,NICE CKS,NICE NG12.
- General Advice:
- If there is any uncertainty about the possible underlying cause of haematuria and an urgent specialist referral is not indicated, seek specialist advice about the need for further assessment and/or referral with a urologist or renal physician, based on clinical judgement NICE CKS.