Haematuria is a frequently encountered presentation in the emergency department (ED). 1,2 Presentation of visible or macroscopic haematuria varies, including presence of clots, retention of urine and concurrence of pain. It may be due to a variety of causes, the most serious being underlying malignant pathology.The positive predictive value (PPV) of visible haematuria (VH) for urological cancer is 10%-22%. 3,4 Prospective cohort studies in United Kingdom (UK) protocol-driven haematuria clinics have revealed an incidence of malignant pathology in 19%-24% of patients with VH vs 3.7%-5.2% for non-visible haematuria. 5-8The majority of malignancies found are urothelial carcinoma (UC) of the bladder. AbstractIntroduction: Visible haematuria (VH) is a very common presentation to the emergency department (ED). In an outpatient setting, 18%-24% of such patients have been shown to have an underlying malignancy. The aim of this study is to determine the malignancy rates of patients presenting acutely to ED and whether the degree of bleeding or presence of clots is a higher risk factor for cancer. Method: We retrospectively collected data from adult patients (>18 years) presenting to ED with VH for a six-month period. Diagnostic outcomes after one year were assessed. Results: Our study population has 96 patients (male = 77, female = 19) with a mean age of 68 years (SD = 20.2). Twenty-eight patients (29%) had haematuria with clots. Twenty-five patients (26%) had a new diagnosis of malignancy, and 10 had a known diagnosis of malignant disease. Bladder cancer was the most commonly found malignancy, in 17 patients (15 new diagnoses), while prostate cancer was second with 14 cases (six new). Renal cancer two, testicular one and colorectal one accounted for the other new malignancies diagnosed following presentation. All but one patient with cancer were male. Although most malignancies were found in patients over 70 years old, the two youngest patients were in their 30s. The incidence of malignancy appears to increase in patients who have urinary blood clots (58%), p = 0.08. Conclusion: A third of patients presenting to ED with VH will have a urological cancer. Patients with VH and clots have a significantly higher incidence of malignancy. We recommend expedited referral of all such patients to a urologist.