How do I differentiate between benign and serious causes of non-visible haematuria in primary care?

To differentiate between benign and serious causes of non-visible haematuria in primary care, consider the patient's age, associated symptoms, and blood test results.

• Age and symptom criteria for urgent referral: Refer urgently via a 2-week wait suspected cancer pathway if the patient is aged 60 years or over with unexplained non-visible haematuria accompanied by dysuria or a raised white cell count on blood tests, as this suggests possible bladder cancer ¹,⁴.
• Persistent or recurrent haematuria: In women aged 45 years or over, visible haematuria that persists or recurs after treatment of a urinary tract infection (UTI) warrants urgent urological referral; similarly, unexplained non-visible haematuria with associated symptoms in older adults requires specialist assessment ¹,⁴.
• Absence of infection and other red flags: Non-visible haematuria without evidence of UTI or other benign causes, especially in older adults, should raise suspicion for malignancy and prompt referral ¹,⁴.
• Benign causes: In younger patients without risk factors or associated symptoms, non-visible haematuria is more likely benign; consider monitoring and treating reversible causes such as infection, trauma, or benign prostatic conditions ¹,².
• Clinical judgement and specialist advice: If there is uncertainty about the cause of haematuria, seek specialist advice from urologists or renal physicians to guide further assessment and management ¹.