Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For patients with unexplained haematuria after initial assessment, follow-up investigations primarily involve referrals based on age and the type of haematuria, often via a suspected cancer pathway.
- Visible Haematuria:
- For individuals aged 45 years and over with unexplained visible haematuria, or visible haematuria that persists or recurs after successful treatment of a urinary tract infection (UTI), a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder or renal cancer is recommended NICE CKS,NICE NG12,NICE CKS.
- In women aged 55 years and over with visible haematuria accompanied by low haemoglobin levels, thrombocytosis, high blood glucose levels, or unexplained vaginal discharge, a direct access ultrasound scan should be considered for endometrial cancer NICE NG12.
- For men with visible haematuria, a prostate-specific antigen (PSA) test and digital rectal examination (DRE) should be considered NICE NG12.
- Non-Visible Haematuria:
- For individuals aged 60 years and over with unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test, a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer is recommended NICE CKS,NICE NG12,NICE CKS.
- General Considerations:
- If an urgent specialist referral is not indicated and there is uncertainty about the possible underlying cause of haematuria, specialist advice from a urologist or renal physician should be sought regarding the need for further assessment and/or referral, based on clinical judgement NICE CKS.