Evaluating haematuria in primary care to rule out urinary tract malignancy

In primary care, the evaluation of haematuria to exclude urinary tract malignancy involves specific referral criteria based on patient age, haematuria type (visible or non-visible), and associated symptoms ².

Visible haematuria that is unexplained or persists/recurs after UTI treatment in individuals aged 45 years and over warrants a suspected cancer pathway referral ². In men, visible haematuria also prompts consideration of a prostate-specific antigen (PSA) test and digital rectal examination ². For women aged 55 and over with visible haematuria, if accompanied by low haemoglobin levels, thrombocytosis, high blood glucose levels, or unexplained vaginal discharge, a direct access ultrasound scan should be considered ².

Non-visible haematuria in individuals aged 60 years and over, when associated with dysuria or a raised white cell count, requires a suspected cancer pathway referral for bladder cancer ².

For women, specific criteria also apply: visible haematuria without UTI, or haematuria that persists or recurs after UTI treatment, in those aged 45 years and over, necessitates a suspected cancer pathway referral for bladder cancer ³,⁴. If a woman is aged 60 years and over and has unexplained non-visible haematuria with dysuria or a raised white cell count, a suspected cancer pathway referral is also indicated ³,⁴.

If there is uncertainty about the cause of haematuria and no urgent referral is indicated, specialist advice should be sought regarding further assessment or referral to a urologist or renal physician ¹.