What are the referral criteria for a patient with haematuria to a urologist?

Referral criteria for a patient with haematuria to a urologist often involve a suspected cancer pathway (2-week wait) due to the potential for underlying malignancy ¹,²,³,⁵.

• Visible Haematuria:
  • Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if they are aged 45 years and over with unexplained visible haematuria either without a urinary tract infection (UTI) or that persists or recurs after successful treatment of a UTI ¹,²,³,⁵.
  • For women aged 55 years and over with visible haematuria, consider a direct access ultrasound scan if there are also low haemoglobin levels, thrombocytosis, high blood glucose levels, or unexplained vaginal discharge ⁵.
  • For men with visible haematuria, consider a prostate-specific antigen (PSA) test and digital rectal examination ⁵.
• Non-Visible Haematuria:
  • Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if they are aged 60 years and over with unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test ¹,²,³,⁵.
• Haematospermia (Blood in Semen):
  • Men over the age of 40 years, and those with recurrent or persistent haematospermia, and/or specific associated symptoms, should be referred to secondary care due to an increased risk of a serious underlying condition, such as malignancy ⁴.
  • Men under the age of 40 years with a single episode of haematospermia can be reassured if no underlying cause is identified by initial assessments and investigation ⁴.
• Other Considerations:
  • If a woman is pregnant and there is persistent haematuria after completion of antibiotic treatment for a UTI, seek urgent specialist advice from an obstetrician regarding ongoing management ¹.
  • If there is any uncertainty about the possible underlying cause of haematuria and urgent specialist referral is not indicated, seek specialist advice about the need for further assessment and/or referral with a urologist or renal physician, depending on clinical judgement ¹.
  • For women aged 60 years and over with recurrent or persistent unexplained urinary tract infections, consider a non-urgent referral for bladder cancer ²,³,⁵.