What criteria should I use to decide whether to refer a patient with hematuria for further urological assessment?

The criteria for referring a patient with haematuria for further urological assessment, particularly via a suspected cancer pathway (2-week wait), depend on the type of haematuria, the patient's age, and associated symptoms ¹,²,³,⁴.

• For Visible Haematuria:
  • Refer people aged 45 years and over using a suspected cancer pathway referral if they have unexplained visible haematuria without a urinary tract infection (UTI) ²,³,⁴.
  • Refer people aged 45 years and over using a suspected cancer pathway referral if they have visible haematuria that persists or recurs after successful treatment of a UTI ¹,²,³,⁴.
  • In men, visible haematuria may prompt consideration of a prostate-specific antigen (PSA) test and digital rectal examination ⁴. If PSA levels are above the age-specific threshold along with visible haematuria or other lower urinary tract symptoms, consider a suspected cancer pathway referral for prostate cancer ⁴.
• For Non-Visible Haematuria:
  • Refer people aged 60 years and over using a suspected cancer pathway referral if they have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test ¹,²,³,⁴.
• Specific Considerations for Women:
  • If a pregnant woman has persistent haematuria after completing antibiotic treatment for a UTI, seek urgent specialist advice from an obstetrician regarding ongoing management ¹.
  • For women aged 60 years and over with recurrent or persistent unexplained UTIs, consider a non-urgent referral for bladder cancer ²,³,⁴.
• General Advice:
  • If there is any uncertainty about the possible underlying cause of haematuria and an urgent specialist referral is not indicated, seek specialist advice about the need for further assessment and/or referral with a urologist or renal physician, based on clinical judgement ¹.