Blood seen within the urine by patient or doctor (VISIBLE) or identified on urine dipstick or MSU (NON-VISIBLE).

Risk of urothelial malignancy: visible haematuria ~20%, non-visible ~3% 

2WW Criteria: suspected bladder / renal


Aged 45 and over and have:

  • Unexplained visible haematuria without urinary tract infection or
  • Visible haematuria that persists or recurs after successful treatment of urinary tract infection


Aged 60 and over and have:

  • unexplained non-visible haematuria, persistent for > 2 weeks, and either dysuria or a raised white cell count on a blood test (new NICE recommendation for 2015).
  • Consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection (new NICE recommendation for 2015).?


Imaging suspicious of bladder or renal cancer


For haematuria patients that do not fulfil 2WW criteria:

  • Refer urgently for cystoscopy via RMS
  • Request urgent renal tract USS at time of referral
  • PSA for all men with visible and non-visible haematuria

Management of recurrent haematuria:

  • Previously investigated recurrent haematuria management is contentious, ongoing visible bleeding may need repeat investigation, discussion or re-referral is advised according to duration/severity etc. 
  • Previously investigated recurrent non-visible haematuria with an apparent cause identified at initial assessment (eg. enlarged prostate, UTI, stone, warfarin use etc) need not be re-referred. 


  • Patients under 40 with non-visible haematuria and proteinuria should have albumin/creatinine ratio measured and initially be referred to a renal physician as per CKD guidelines.



NICE, 2015. Suspected cancer: recognition and referral



Date reviewed       January 2022

Next review date   January 2023

Sifter                      Dr Bridgitte Wesson, GP and Kernow RMS GP Urology guideline lead

Contributors          Mr Christopher Blake, Consultant Urologist, RCHT


Version 3.1