Haematuria/Bladder lesion Referral Access Criteria

Referrers should use this page when referring patients to public adult urology outpatient services for haematuria/bladder lesion.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department 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

Immediate referral
Immediately contact on-call registrar or service to arrange immediate urology assessment (seen within 7 days):
Nil To contact the relevant service, see Clinician Assist WA: Acute Urology Assessment (external site)

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
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 information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason). This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History	Nil
Examination	Nil
Investigations	MSU or CSU M/C/S (mandatory for Haematuria) Urinary tract USS or CT Urogram / CT IVP (mandatory for bladder lesion)

Highly desirable
History	Nil
Examination	Nil
Investigations	U&Es Urine cytology results PSA (males) Albumin/Creatinine Ratio PCR Chlamydia/Gonococcus

Indicative clinical urgency 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 years, 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 also refer to Nephrology in addition to Urology
Category 3 Appointment within 365 days	No defined category 3 criteria

Indicative clinical urgency 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 years, 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 also refer to Nephrology in addition to Urology

Category 3

Appointment within 365 days

Exclusions
Nil

Useful information
Nil

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Last reviewed: 09-06-2023

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