Urology clinical guideDoncaster Royal InfirmaryDoncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

HomeEmergency management

Gross haematuria

Assess bleeding severity, relieve clot retention and arrange the correct urgent pathway.

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Visible haematuria flowchart

  1. Visible haematuriaCheck observations, pain, clots, anticoagulants and bleeding severity. Send FBC, U&E, coagulation and group-and-save when indicated. Cover UTI: urinalysis, culture if suspected, and treat proven infection using current DBTH guidance.
  2. Unstable or major ongoing bleeding?Shock, falling haemoglobin, transfusion concern or rapidly increasing bleeding.
  3. Yes — resuscitateED senior + urgent Urology. Use current major-haemorrhage/reversal pathways when indicated.
    No — continueIs the patient passing urine?
  4. Is the patient passing urine?A painful distended bladder or inability to void indicates clot retention.
  5. Yes — clinically wellClinically well: urgent suspected-cancer (2WW) referral when NICE criteria are met. Treat proven UTI and safety-net.
    No — clot retentionUnable to pass urine = clot retention. Insert a 22–24 Fr three-way catheter and wash out/irrigate by a competent clinician.
  6. If catheterisation fails: call the Surgical SHOAlso escalate recurrent blockage, persistent bleeding, sepsis, AKI or uncontrolled pain.

2WW rule

Use the suspected cancer pathway for adults aged 45 and over with unexplained visible haematuria without UTI, or visible haematuria that persists or recurs after successful UTI treatment.