Visible haematuriaBMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-067395 (Published 01 February 2022) Cite this as: BMJ 2022;376:e067395
- Anika Madaan, medical student1,
- Naimish Gandhi, general practitioner2,
- Sanjeev Madaan, consultant urologist and visiting professor3
- 1Faculty of Medicine, Imperial College London, London, UK
- 2Jubilee Medical Centre, Kent House Surgery, Longfield, UK
- 3Department of Urology and Nephrology, Dartford and Gravesham NHS Trust; Institute of Medical Sciences, Canterbury Christchurch University, UK
- Correspondence to S Madaan
What you need to know
Refer patients aged over 45 who present with unexplained visible haematuria (or persistent visible haematuria following successful treatment of a urinary tract infection) via an urgent cancer referral pathway
Patients with visible haematuria who are treated for urinary tract infection should have a repeat urine dipstick after completing their antibiotic course. If haematuria persists, refer them for further assessment
Offer transvaginal ultrasound imaging to women aged 55 and over who present with visible haematuria and either low haemoglobin levels, thrombocytosis, or high blood glucose levels, to assess for endometrial cancer
Charlie, 42, calls for an urgent GP appointment because he noticed blood in his urine two days ago. It has settled now. After reading about the topic online, he is concerned it may be something serious.
The most common presentation of bladder cancer is visible haematuria,1 which occurs in around 80% of patients. A full time GP might expect to diagnose bladder cancer in approximately one person every three to five years.2 However, not all people with visible haematuria have cancer, and other differentials may include calculi, benign prostatic hyperplasia, and urinary tract infection (UTI). This article outlines the initial assessment of a patient presenting with visible haematuria, including features in the history and examination that may point towards malignant and non-malignant causes, and thresholds for referral for further investigation. We also highlight differences in how to assess male and female patients.
In this article we refer to men, but intend this to include any person who has a prostate; likewise, when we use the term women we also include any person with a uterus.
What you should cover
Much of the initial assessment of visible haematuria is targeted at estimating …