investigation of non-visible haematuria in 82 year old female

Recommended investigations for non-visible haematuria in an 82-year-old female:

• Refer the patient using a suspected cancer pathway referral if she is aged 60 years or over with unexplained non-visible haematuria accompanied by dysuria or a raised white cell count on a blood test, due to suspicion of bladder cancer.
• Consider urine microscopy and culture to exclude urinary tract infection, as persistent non-visible haematuria without infection warrants further investigation.
• Arrange imaging of the urinary tract, typically an ultrasound scan of the kidneys and bladder, to detect possible renal or bladder pathology such as tumours or stones.
• Consider cystoscopy to directly visualize the bladder and urethra to identify sources of bleeding or lesions suspicious for malignancy.
• Evaluate other relevant blood tests including renal function and full blood count to assess for associated abnormalities.
• In women aged 55 and over with visible haematuria and additional concerning features (e.g., low haemoglobin), consider direct access pelvic ultrasound to rule out endometrial pathology, although for non-visible haematuria without these features this is less immediate.

These investigations aim to exclude urological cancers (especially bladder and renal) and other causes of haematuria in an elderly female, with urgent referral criteria determined by age and associated symptoms or test results NICE CKS,NICE NG12,NICE CKS.