Non-Visible Haematuria Pathway - Adult Leeds

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1 Background Information / Scope of Pathway

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This pathway has been developed jointly by the Leeds CCG planned care leads, Continence Urology and Colorectal Service (CUCS)
and consultants from Urology, Urogynaecology and Elderly Medicine within LTHT.

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2 Development & Updates to this Pathway

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Developed November 2014

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4 Suspicion of UTI on Urinalysis or Clinically Send MSU

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People > 65 years: do not treat asymptomatic bacteriuria; it is common but is not associated with increased morbidity 1

1 Abrutyn E, Mossey J, Berlin JA, Boscia J, Levison M, Pitsakis P, Kaye D. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women? Ann Int Med 1994:827-33. A cohort study and a controlled
trial found that bacteriuria was not an independent risk factor for mortality in elderly women without catheters, and that its treatment did not lower the mortality rate.

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6 UTI Confirmed Treat as Appropriate

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For further information about prescribing antibiotics please see Leeds Health Pathways guidance for:
Lower UTI in Women (no fever or flank pain)
Lower UTI in Men (no fever or flank pain)

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7 Repeat Urinalysis

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GP Information:
The presence of non-visible haematuria on 2 out of 3 occasions in the absence of a urinary tract infection.
2+ or 3+ on dipstick urinalysis has a good positive predictive value for haematuria and does not need confirming with microscopy. Trace or 1+ should be confirmed on microscopy and 10 RBC / microlitre is regarded as significant.

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12 Refer One Stop Haematuria Clinic

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LTHT One Stop Haematuria Clinic
Single visit process will include:

  • Consultation
  • USS
  • Flexible Cystoscopy

GP Information
The following tests are recommended to accompany referral:

  • U&E, creatinine, eGFR, HbA1C
  • FBC
  • PSA (male) - (see note 1 below)
  • Blood pressure

Please note if you are referring to an alternative provider please review provider guidance about required pre-referral tests (e.g. Ultrasound) prior to making referral.

Note 1
PSA should be checked in male patients (after counselling):

  1. Above the age of 50 years old, with greater than 10 years life expectancy
  2. Between 40-50 years old with family history of prostate cancer or of African decent
  3. With an abnormal feeling prostate

Key Dates

Published: 18-Dec-2014, by Leeds
Valid until: 01-Dec-2016