What are the referral criteria for a patient with haematuria to a urologist?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Referral criteria for a patient with haematuria to a urologist often involve a suspected cancer pathway (2-week wait) due to the potential for underlying malignancy ,,,.

  • Visible Haematuria:
    • Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if they are aged 45 years and over with unexplained visible haematuria either without a urinary tract infection (UTI) or that persists or recurs after successful treatment of a UTI ,,,.
    • For women aged 55 years and over with visible haematuria, consider a direct access ultrasound scan if there are also low haemoglobin levels, thrombocytosis, high blood glucose levels, or unexplained vaginal discharge .
    • For men with visible haematuria, consider a prostate-specific antigen (PSA) test and digital rectal examination .
  • Non-Visible Haematuria:
    • Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if they are aged 60 years and over with unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test ,,,.
  • Haematospermia (Blood in Semen):
    • Men over the age of 40 years, and those with recurrent or persistent haematospermia, and/or specific associated symptoms, should be referred to secondary care due to an increased risk of a serious underlying condition, such as malignancy .
    • Men under the age of 40 years with a single episode of haematospermia can be reassured if no underlying cause is identified by initial assessments and investigation .
  • Other Considerations:
    • If a woman is pregnant and there is persistent haematuria after completion of antibiotic treatment for a UTI, seek urgent specialist advice from an obstetrician regarding ongoing management .
    • If there is any uncertainty about the possible underlying cause of haematuria and urgent specialist referral is not indicated, seek specialist advice about the need for further assessment and/or referral with a urologist or renal physician, depending on clinical judgement .
    • For women aged 60 years and over with recurrent or persistent unexplained urinary tract infections, consider a non-urgent referral for bladder cancer ,,.

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