HNY Policy and Pathway Repository - Humber

Suspected kidney cancer

Suspected urological cancer

Suspected urothelial cancer

Visible (macroscopic) haematuria – any age, one episode or more

Non-visible (microscopic) haematuria (Defined as at least x2 or more positive dipstick, not trace)

• Age > 40 and < 60 presenting with ≥ 2 occasions of microscopic haematuria +/- UTI
• Age ≥ 60 AND Lower Urinary Tract Symptoms &/or ≥ 2 occasion of microscopic haematuria

Visible or non-visible haematuria with loin or pelvic pain

Exclude red Flags

Testicular cancer - referral for testicular cancer in men if they have a non-painful enlargement or change in shape or texture of the testis.

Consider a suspected cancer pathway referral for penile cancer in men if they have either:

• a penile mass or ulcerated lesion, where a sexually transmitted infection has been excluded as a cause
• a persistent penile lesion after treatment for a sexually transmitted infection has been completed
• men with unexplained or persistent symptoms affecting the foreskin or glans

Penile cancer will be referred to Leeds following a confirmed diagnosis

Raised PSA with the absence of haematuria – refer on suspected prostate cancer pathway

Please perform U&E’s and PSA (if applicable and with informed consent). Results required at triage but do not change pathway or acceptance of referral

Refer people using a suspected cancer pathway for renal / urothelial / bladder cancer if they have the following:

Visible (macroscopic) haematuria – any age, one episode or more

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

Or

Non-visible (microscopic) haematuria (Defined as at least x2 or more positive dipstick, not trace)

• Age > 40 and < 60 presenting with ≥ 2 occasions of microscopic haematuria +/- UTI
• Age ≥ 60 AND Lower Urinary Tract Symptoms &/or ≥ 2 occasion of microscopic haematuria

Or

Visible or non-visible haematuria with loin or pelvic pain

Do Not Refer:

Age < 60 & / or First proven UTI, & / or < 2 occasions of non-visible microscopic haematuria or trace only – No investigations required

Age < 40 AND ≥ 2 occasions of non-visible microscopic haematuria - Referral to nephrology. Urology not indicated

Haematuria pathway referral form to be completed and referred via ERS (Referral form on ARDENS)

Patient leaflet

Perform U&E in all patients at time of referral. N.B. Referrals with test not placed will be rejected.

Perform PSA if applicable, and with informed consent

Haematuria faster diagnostic referral form to be completed