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 / renalcancer
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