What follow-up investigations are recommended for patients with unexplained haematuria after initial assessment?

For patients with unexplained haematuria after initial assessment, follow-up investigations primarily involve referrals based on age and the type of haematuria, often via a suspected cancer pathway.

• Visible Haematuria:
  • For individuals aged 45 years and over with unexplained visible haematuria, or visible haematuria that persists or recurs after successful treatment of a urinary tract infection (UTI), a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder or renal cancer is recommended ¹,³,⁴.
  • In women aged 55 years and over with visible haematuria accompanied by low haemoglobin levels, thrombocytosis, high blood glucose levels, or unexplained vaginal discharge, a direct access ultrasound scan should be considered for endometrial cancer ³.
  • For men with visible haematuria, a prostate-specific antigen (PSA) test and digital rectal examination (DRE) should be considered ³.
• Non-Visible Haematuria:
  • For individuals aged 60 years and over with unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test, a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer is recommended ¹,³,⁴.
• General Considerations:
  • If an urgent specialist referral is not indicated and there is uncertainty about the possible underlying cause of haematuria, specialist advice from a urologist or renal physician should be sought regarding the need for further assessment and/or referral, based on clinical judgement ¹.