Haematuria

Differential diagnosis

  • Bladder Ca – occupation, smoker, FH
  • Prostate Ca – weight loss, back pain
  • Renal Ca
  • UTI – dysuria, frequency
  • Renal stones – episodic abdominal/flank pain
  • Trauma
  • Non-urological – PMB, vaginal discharge

Data gathering

  • Red flags – weight loss, back pain
  • Others – UTI, BPH
  • Examine – abdominal exam, PR, BP

Clinical management

  • Investigations
    • Bloods – FBC, U+E, Clotting
    • Urine dip
    • Urine ACR
    • Others
      • USS KUB
      • PSA

2ww referral if:

  • >40 with recurrent or persistent UTI
  • >50 with microscopic haematuria without obvious cause
  • Any age with macroscopic haematuria without obvious cause

Microscopic haematuria

Definition: non-visible haematuria on 2 out of 3 samples (in the absence of a UTI)

2+ or more on dipstick does not need confirming on microscopy

Trace or 1+ should be confirmed on microscopy – 10 RBC/microlitre is considered significant