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Haematuria Bladder lesion

Haematuria / Bladder lesion – Adult

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

  • Severe urinary tract bleeding resulting in clot retention and/or symptomatic anaemia
  • Visible haematuria following trauma

Immediately contact on-call registrar or service to arrange an immediate urology assessment (seen within 7 days) for:

  • Nil

To contact the relevant service, please see HealthPathways: Acute Urology Assessment

Presenting issues
  • Visible haematuria
  • Non-visible haematuria in the absence of a UTI confirmed through successive midstream specimens of urine collected at least a week apart
  • Imaging suggestive of bladder lesion
Mandatory referral information (referral will be returned if this information is not included)

Investigations

  • MSU or CSU M/C/S (mandatory for haematuria)
  • Urinary tract USS or CT Urogram / CT IVP (mandatory for bladder lesion)

If unable to attach reports, please include relevant information/findings in the body of the referral.

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)
Highly desirable referral information
  • U&Es
  • Urine cytology results
  • PSA (males)
  • Albumin/Creatinine ratio
  • PCR Chlamydia / Gonococcus
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • Visible or persistent (> 3 months) microscopic haematuria in the absence of a UTI in an individual aged >40 years.
  • Non-visible haematuria with risk factors (male, >50, smoking history, family or personal history of urothelial cancer):
    • Renal parenchymal mass ≥3cm
    • Bladder or collecting system mass
    • Unexplained isolated hydronephrosis
  • In the absence of urinary tract infection or other obvious benign cause, or persists despite maximum medical treatment i.e. antibiotics 
Category 2
Appointment within 90 days
  • Haematuria in an individual <40 years
  • Renal parenchyma mass <3cm
  • Persistent (> 6 weeks) unexplained microscopic haematuria
  • If decline in GFR or proteinuria (NB: also refer to nephrology in addition to urology)
Category 3
Appointment within 365 days
  • No defined category 3 criteria
Last reviewed: 09-06-2023
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