What are the key indications for referring a patient for cystoscopy in the context of suspected bladder pathology?

Key indications for referring a patient for cystoscopy in suspected bladder pathology include:

• Visible and unexplained haematuria in people aged 45 and over, either without urinary tract infection or persisting/recurring after treatment, warrants referral via a suspected cancer pathway for bladder or renal investigation, including cystoscopy.
• Non-visible (microscopic) haematuria with dysuria or raised white cell count in people aged 60 and over should prompt referral for cystoscopy to investigate possible bladder cancer.
• Dysuria accompanied by unexplained non-visible haematuria in people aged 60 and over is an indication for suspected cancer pathway referral and cystoscopy.
• Recurrent or persistent unexplained urinary tract infections in people aged 60 and over may justify a non-urgent referral for bladder cancer assessment, which can include cystoscopy.
• Other unexplained lower urinary tract symptoms, especially if persistent or associated with haematuria or increased urinary tract infections, may also indicate the need for cystoscopy as part of the investigation.

These indications align with NICE guidance on suspected cancer recognition and referral pathways, emphasising cystoscopy as a key diagnostic tool for bladder pathology when these clinical features are present.