Consultant-led fast-track diagnostic pathway for blood in urine. Full assessment is typically completed within 5–10 working days.
Blood in the urine (haematuria) should always be investigated, even if it occurs only once. Around 1 in 5 adults aged 45 and over with visible blood in the urine are found to have a urological cancer, most commonly bladder cancer. UK NICE guidance requires anyone aged 45 or over with unexplained visible haematuria to be referred to a urologist on a 2-week-wait pathway.
This rapid access clinic, led by Consultant Urological Surgeon Mr Neil Haldar, delivers the full diagnostic pathway — consultation, urine and blood tests, imaging, and flexible cystoscopy — typically within 5–10 working days. Clinics are available for patients from across Buckinghamshire, Berkshire, West Herts and Oxfordshire.
Read my full-length article on the causes and diagnosis of blood in the urine
About Mr Neil Haldar
Mr Neil Haldar is a Consultant Urological Surgeon at Buckinghamshire Healthcare NHS Trust, where he served as urology cancer lead and laparoscopic urology lead, and established the da Vinci robotic prostate surgery programme. His subspecialty is urological cancer — prostate, kidney, and bladder — with over 1,000 prostatectomies and 600 laparoscopic renal cancer operations performed personally.
Mr Haldar personally assesses every patient through this service from the first consultation through to diagnosis and, where required, treatment.
GMC: 3683914 | BUPA Platinum Consultant
Why a Rapid Access Haematuria Clinic Matters
Blood in the urine can be visible — pink, red, brown, or tea-coloured urine — or detected only on a urine dipstick. Either form can be the first sign of an underlying urological condition, including bladder, kidney, or prostate cancer.
This rapid access service compresses the entire pathway — consultation, urine and blood tests, imaging, and cystoscopy — into a typical window of 5–10 working days.
The objective is straightforward: identify the cause quickly, reassure where appropriate, and ensure that any serious condition is diagnosed and treated without delay.
Visible blood in the urine should always be investigated, even if it happens once and then clears.
What Is Haematuria?
Haematuria is the medical term for blood in the urine. It falls into two clinically distinct categories:
| Type | Appearance | Detection | Cancer Risk in Adults 45+ |
|---|---|---|---|
| Visible haematuria (VH) | Urine appears pink, red, brown, or tea-coloured | Seen by the patient | Approximately 10–20% |
| Non-visible haematuria (NVH) | Urine appears normal | Detected on urine dipstick or laboratory testing | Approximately 3–5% |
Both forms are clinically important. Visible haematuria is the more concerning of the two and triggers an urgent (2-week-wait) referral under NICE guidance.
Common Causes of Blood in the Urine
Haematuria can arise from anywhere in the urinary tract — kidneys, ureters, bladder, prostate, or urethra. The most frequent causes are:
- Urinary tract infection — the most common cause in adult women
- Kidney or ureteric stones — often dramatic but treatable
- Benign prostatic enlargement (BPH) — the leading benign cause in men over 50
- Bladder inflammation or interstitial cystitis
- Vigorous exercise — should resolve within 48–72 hours
- Anticoagulant medication — but rarely the sole cause
- Bladder cancer — most often presents as painless visible haematuria
- Kidney cancer — increasingly detected incidentally on imaging
- Prostate cancer — uncommon as a primary cause
Most patients with haematuria do not have cancer. However, because cancer accounts for a clinically significant minority — particularly in adults over 45 with visible bleeding — the cause should never be assumed without proper investigation.
When to Seek Assessment
You should arrange a urological assessment if you have:
- Visible blood in the urine, even once, particularly if painless
- Recurrent episodes of discoloured urine
- Microscopic blood detected on a urine test
- Blood in the urine with urinary frequency, urgency, or burning
- Blood in the urine with flank, loin, or abdominal pain
- Recurrent urinary infections alongside haematuria
- A history of smoking — current or former
- Unexplained weight loss, fatigue, or bone pain with haematuria
Urgent (Same-Day) Attention
Seek same-day medical attention if you are:
- Unable to pass urine
- Passing large clots
- Feeling faint or unwell
- Experiencing severe pain
- Showing signs of infection (fever, rigors, sepsis symptoms)
NICE Guidance and the 2-Week-Wait Pathway
Under NICE guideline NG12 (Suspected cancer: recognition and referral), GPs are required to make an urgent (2-week-wait) referral when:
| Patient Profile | NICE Recommendation |
|---|---|
| Adult aged 45+ with unexplained visible haematuria, without UTI | 2-week-wait referral |
| Adult aged 45+ with visible haematuria that persists or recurs after successful UTI treatment | 2-week-wait referral |
| Adult aged 60+ with non-visible haematuria plus dysuria or raised white cell count | 2-week-wait referral |
| Adult aged 45+ with unexplained visible haematuria | Consider 2-week-wait referral |
If you meet these criteria but want to be seen sooner, this rapid access clinic delivers the same NICE-aligned pathway in a private setting, typically within 5–10 working days.
The Pathway
1. Consultant Consultation
A 30–45 minute consultation reviewing your symptoms, history, medication, and any previous tests.
2. Urine and Blood Tests
- Urine dipstick, microscopy, culture
- Urine cytology (looking for abnormal cells)
- Blood tests: kidney function, full blood count, PSA in men where appropriate
3. Imaging
The gold-standard test is a CT urogram — a contrast-enhanced CT of the kidneys, ureters, and bladder, capable of detecting stones, tumours, and structural abnormalities. Ultrasound is used as an initial test in selected lower-risk patients.
4. Flexible Cystoscopy
A small flexible camera is passed into the bladder under local anaesthetic gel. The procedure takes around 5 minutes and is the only reliable way to exclude bladder cancer.
5. Results, Diagnosis, and Plan
A follow-up consultation reviewing all findings, explaining the diagnosis, and agreeing the next steps. If treatment is required, continuity of care is maintained throughout — the same consultant who diagnoses you treats you.
Typical timeline: 5–10 working days from first contact to full diagnosis.
Clinic Locations
Choose the site most convenient for you. The same consultant and the same pathway apply at every location.
| Location | County | Consultation | Cystoscopy | CT / MRI / Ultrasound |
|---|---|---|---|---|
| Chiltern Hospital, Great Missenden | Buckinghamshire | ✓ | ✓ | ✓ |
| Clementine Churchill Hospital, Harrow | Middlesex | ✓ | ✓ | ✓ |
| GenesisCare, Windsor | Berkshire | ✓ | ✓ | ✓ |
| Shelburne Hospital, High Wycombe | Buckinghamshire | ✓ | — | ✓ (arranged) |
| Beaconsfield Clinic | Buckinghamshire | ✓ (selected dates) | — | — |
Notes for clinic-only sites: Patients seen at the Shelburne Hospital or Beaconsfield Clinic who require flexible cystoscopy or other procedures will have these arranged at Chiltern Hospital, Clementine Churchill Hospital, or GenesisCare Windsor — usually within the same week.
The catchment includes south Oxfordshire (Henley, Thame, Wallingford), Buckinghamshire, West Herts, East Berkshire and North-West London.
Who This Clinic Is For
The service is suitable for men and women with:
Why Early Diagnosis Matters
For bladder cancer, stage at diagnosis is the strongest predictor of outcome. Non-muscle-invasive bladder cancer detected early has a 5-year survival of over 90%. Muscle-invasive disease has a 5-year survival of around 50%. The difference is often a matter of months — the time taken from first noticing blood in urine to receiving a diagnosis.
The same principle applies to kidney cancer. Tumours detected when small and confined to the kidney are typically curable with partial nephrectomy. Tumours detected late may require radical surgery or systemic therapy.
This is why the clinic exists: to compress that diagnostic window for patients who would otherwise wait.
Frequently Asked Questions
How quickly can I be seen?
Most patients are seen within 2–5 working days of their initial enquiry. Same-day appointments are often available. The full diagnostic pathway is typically completed within 5–10 working days, subject to scan and clinic availability.
Which location should I choose?
Choose whichever site is most convenient for you. Chiltern Hospital, Princess Margaret Hospital, and GenesisCare Windsor can all deliver the complete pathway in one place. The Shelburne and Beaconsfield sites are excellent for the initial consultation, with any procedures arranged at one of the full-service centres.
Do I need a GP referral?
Most insurers require a GP referral letter to authorise treatment. Self-pay patients can usually be seen without a referral, though one is recommended for continuity of care.
Will the cystoscopy hurt?
Flexible cystoscopy is performed under local anaesthetic gel and is well tolerated by the vast majority of patients. The procedure itself takes around 5 minutes. Most patients describe it as briefly uncomfortable rather than painful.
What if cancer is found?
If a urological cancer is identified, you remain under my direct care. Your case will be discussed at a multidisciplinary team (MDT) meeting. As a high-volume robotic and laparoscopic cancer surgeon, I can usually offer the full range of treatment options — robotic surgery, laparoscopic surgery, and intravesical therapy — without onward referral. I work closely with other cancer surgeons and oncologists for any treatment outside of my usual practice
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Related Reading
Mr Neil Haldar, MBBS, MD, FRCS(Eng), FRCS (Urol). Consultant Urological Surgeon, Buckinghamshire Healthcare NHS Trust. GMC 3683914.