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

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


2WW Criteria: 


- 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, or
- 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



Management prior to referral:



**In all cases please request urgent/2WW renal tract USS at referral** 


  • Haematuria patients that do not fulfil 2WW criteria should be referred urgently, and will be booked a cystoscopy. Please do not make C&B outpatient referrals.  
  • Recurrent haematuria management is contentious, ongoing visible bleeding may need repeat investigation, discussion or re-referral is advised according to duration/severity etc. 
  • 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.