A single episode of visible haematuria in an adult, without a clear benign cause, carries a meaningful risk of urothelial cancer and warrants cystoscopy and upper tract imaging. Anticoagulation does not explain it away; bleeding on anticoagulants often unmasks underlying disease.
Treating a urinary infection first is reasonable if one is confirmed, but the haematuria should be rechecked and investigated if it persists or if the patient has risk factors such as smoking or occupational exposure.
- Refer adults with unexplained visible haematuria for cystoscopy and upper tract imaging
- Do not attribute haematuria to anticoagulation without investigation
- Ask about smoking and occupational chemical exposure
- Recheck after treating a confirmed urinary infection
Why it matters
Delay in investigating haematuria is a common route to late-stage urothelial cancer.
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