Rapid diagnostic testing may significantly improve outcomes for patients who arrive at emergency departments with visible blood in their urine, mitigating the surprisingly high risk for serious illness and death, new research shows. 

Findings from the WASHOUT study showed the median length of stay in the hospital for people with hematuria was 4 days with a 90-day mortality rate of nearly 10% and a 90-day readmission rate of around 15%. Around a quarter had an underlying cancer, most commonly bladder cancer, yet almost half of patients did not undergo imaging during their hospital admission.

“What our study really highlights is that admission with hematuria is a window of opportunity that we’re often not using,” said Kevin Byrnes, MD, co-lead of the study and a urology researcher at University College London Hospital, in England. “If a patient is already in hospital for several days, that’s the moment to establish a diagnosis. Too often the focus is simply on clearing the bleeding and sending the patient home, when the priority should be finding the underlying cause.”

Byrnes presented the results at the European Association of Urology (EAU) 2026 Annual Meeting.

Visible blood in the urine, known as macroscopic hematuria, accounts for around 15% of all acute admissions under urology and may have many possible causes, including benign conditions such as infection or prostate enlargement to life-threatening diseases including bladder cancer. The average patient age is almost 80 years, so these people are medically complex, high-risk, and often require a long length of stay of around 10 days. 

“Hematuria is almost a syndrome rather than a single condition,” Byrnes told Medscape Medical News. “Patients may have multiple underlying causes at the same time, and that can make management more complicated. Without a single diagnostic pathway, patients presenting to emergency departments may sometimes fall between existing clinical processes.”

To better understand how patients admitted via emergency with hematuria are managed, the research team conducted a prospective, international observational study using the trainee-led British Urology Researchers in Surgical Training collaborative network. Worldwide, 379 sites with nearly 9000 participants are in the program. To date, 110 sites have been recruited in this UK, covering over 50% of all UK-based urology units.

The primary outcome of the study is length of stay in the hospital; secondary outcomes include 90-day mortality , 90-day readmission, and time to diagnosis. Patients were followed for 90 days after their presentation.

“Our key aims are to establish trends in diagnosis, describe current inpatient management practices and see how much variation there in this across the UK and internationally. We are also associating patterns of management with key outcome s,” Byrnes said. 

Diagnostic Interventions Delayed 

The preliminary findings, from 8500 patients, revealed many patients arriving at the hospital with hematuria were seriously ill. Around 5% were hemodynamically unstable, another 5% were septic, and 11% required high-dependency care on admission, according to the researchers. More than 1 in 5 patients required a blood transfusion. 

The median hospital stay was 4 days, although this outcome varied significantly across European countries. Despite prolonged admissions, diagnostic investigations were often delayed or not performed at all, Byrnes reported. Results showed that nearly 47% of patients did not undergo imaging during their hospital stay , and only 35% received an intervention such as cystoscopy or surgery to address the bleeding. 

The study also highlighted the substantial risk for underlying cancer in this group of patients. Overall, around one-fourth of patients presenting with visible hematuria had an underlying malignancy, either previously diagnosed or newly detected, Byrnes said. 

“When diagnostic testing was performed during the hospital admission, cancers were typically identified rapidly, often within one day on average,” he said. When patients were discharged without investigation and referred to outpatient pathways, diagnosis was delayed significantly, with the average time to diagnosis extending significantly. “That can delay treatment for conditions such as bladder cancer,” he said. 

Byrnes noted that time between admission and completion of management was significantly associated with increasing length of stay and an increased risk for readmission and death (P < .01). Specifically, patients with 2 days or longer between admission and completion of management had an average increase in length of stay of 5.6 days, a 3.1% greater probability of readmission, and a 2.5% greater probability of death within 90 days.

“Mortality was higher among patients who did not undergo imaging in the emergency department, lacked a definitive diagnosis during admission, or had malignancy as the underlying cause of hematuria,” Byrnes added. “In many cases these patients sit in hospital beds for several days without getting the scans they need. That’s exactly the time when we should prioritize obtaining a diagnosis. Those scans are often going to be done anyway through outpatient pathways within a couple of weeks, so in that sense, bringing the imaging forward during the admission can be both clinically useful and more efficient for the healthcare system.”

The study also revealed striking variation in management practices across countries and hospitals. According to the researchers, these differences likely reflect the absence of evidence-based guidelines for emergency hematuria. “That variability is one of the reasons we undertook this study,” Byrnes said. 

The researchers said they hope the findings will help inform future clinical guidance, and ultimately, believe that a more standardized approach to emergency hematuria could improve outcomes for patients while also reducing the burden on hospitals.

“We’re dealing with patients who are often older, frail, and medically complex,” Byrnes said. “But if we focus first on establishing the cause of the bleeding, we may be able to shorten hospital stays, accelerate cancer diagnoses, and improve outcomes overall.”

Joost Boormans, MD, PhD, head of urology at Erasmus University Medical Center, in Rotterdam, Netherlands, called the new research “an important study highlighting the scale of the problem that emergency blood in the urine presents, both for patients and our already over-stretched healthcare systems. It’s difficult to draw strong conclusions about specific conditions because blood in the urine can be caused by many things, including cancer, and this group of patients is very diverse.”

However, he said, the findings show timely investigative tests were beneficial. Early scans “can accelerate diagnosis and reduce patients’ risk of readmission and long hospital stays, both being significantly high as shown in the WASHOUT study. As urologists in emergency care, we should be aware of these numbers and do more to get an immediate diagnosis for people with blood in urine, to reduce the burden on our healthcare systems and give our patients the best outcomes.”

Byrnes and Boormans reported no relevant financial conflicts of interest. 

Becky McCall is a journalist based in London.