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Haematuria

Definition:  

Blood seen within the urine by patient or doctor (VISIBLE) or identified on urine dipstick or MSU (NON-VISIBLE).

Risk of urothelial malignancy: visible haematuria ~20%, non-visible ~3%

 

2WW Criteria: suspected bladder / renalcancer 

Aged 45 and over and have:

  • Unexplained visible haematuria without urinary tract infection or
  • Visible haematuria that persists or recurs after successful treatment of urinary tract infection

 

Aged 60 and over and have:

  • unexplained non-visible haematuria, persistent for > 2 weeks, and either dysuria or a raised white cell count on a blood test

 

Imaging suspicious of bladder or renal cancer

 

For haematuria patients that do not fulfil 2WW criteria:

  • Refer urgently (this will go direct to cystoscopy)
  • Request urgent renal tract USS at time of referral
  • PSA for all men with visible and non-visible haematuria

Investigations

  • A 'trace' of haematuria on dipstick should be considered negative, and only ≥ 1+ should be considered positive because of the sensitivities of the test sticks.
  • If asymptomatic then 2 out of 3 dipsticks should be positive before further investigation is warranted (≥ 1+ blood).
  • Do not attribute microscopic haematuria to aspirin or warfarin.

Management of recurrent haematuria:

  • Previously investigated recurrent haematuria management is contentious, ongoing visible bleeding may need repeat investigation, discussion or re-referral is advised according to duration/severity etc. 
  • Previously investigated recurrent non-visible haematuria with an apparent cause identified at initial assessment (eg. enlarged prostate, UTI, stone, warfarin use etc) need not be re-referred. 

 

  • Patients under 40 with non-visible haematuria and proteinuria should have albumin/creatinine ratio measured and initially be referred to a renal physician as per CKD guidelines.

 

 

References

NICE, 2015. Suspected cancer: recognition and referral

 

Contributors

Mr Christopher Blake, Consultant Urologist, RCHT

Dr Stephanie Jackson, GP Lead Urology

 

Reviewed: July 2018