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Half of visible and half of recurrent visible hematuria cases have underlying pathology: prospective large cohort study with long-term followup

Half of visible and half of recurrent visible hematuria cases have underlying pathology: prospective large cohort study with long-term followup
Half of visible and half of recurrent visible hematuria cases have underlying pathology: prospective large cohort study with long-term followup

Purpose: visible hematuria has a cancer yield of up to 24.2%. A large proportion of cases will have no etiology. In this study we determined the incidence of pathology (benign and malignant) in patients with visible hematuria and those with persistent and recurrent visible hematuria, and evaluated the policy for investigations.

Materials and methods: data were prospectively collected for 1,804 patients with visible hematuria at a United Kingdom teaching hospital from January 1999 to September 2007. In October 2010 the comprehensive hospital electronic database was checked for every individual patient to ensure no urological pathology was missed. All patients underwent standard hematuria investigations, including renal tract ultrasound and excretory urography or contrast enhanced computer tomography urogram, flexible cystoscopy and urine cytology.

Results: the male-to-female ratio was 4.8:1. Median age ± SD was 67 ± 17.0 years (range 21 to 109). Median followup was 6.6 ± 2.5 years (range 1.5 to 11.6). No urological pathology was found in 965 (53.5%) patients. Malignant urological disease was found in 386 (21.4%) patients, of whom 329 had bladder tumors. There were 32 patients with persistent visible hematuria and no malignancy. Repeat investigation was performed in 69 patients reporting recurrence. Of these patients 35 received a significant urological diagnosis, including 12 (17.4%) urological malignancies, while 34 (49.3%) still had no diagnosis. Limitations include the possibility of missing pathology.

Conclusions: almost 50% of patients presenting with visible hematuria will have a diagnosis. Therefore, all cases of visible hematuria require full standard investigations. Patients with no diagnosis can be discharged from followup. Recurrent visible hematuria after full initial negative findings requires repeat full standard investigations because 11.6% will have malignant pathology.

Adult, Aged, Aged, 80 and over, Carcinoma, Transitional Cell, Female, Hematuria, Humans, Kidney Neoplasms, Male, Middle Aged, Prostatic Diseases, Recurrence, Smoking, Urinary Bladder Neoplasms, Journal Article
0022-5347
1561-1565
Mishriki, Said Fadel
1cdff697-8825-49da-9432-c385f4a2c415
Vint, Ross
67577729-fb42-4885-aed1-56a332aa9cca
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Mishriki, Said Fadel
1cdff697-8825-49da-9432-c385f4a2c415
Vint, Ross
67577729-fb42-4885-aed1-56a332aa9cca
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Mishriki, Said Fadel, Vint, Ross and Somani, Bhaskar K (2012) Half of visible and half of recurrent visible hematuria cases have underlying pathology: prospective large cohort study with long-term followup. The Journal of Urology, 187 (5), 1561-1565. (doi:10.1016/j.juro.2011.12.100).

Record type: Article

Abstract

Purpose: visible hematuria has a cancer yield of up to 24.2%. A large proportion of cases will have no etiology. In this study we determined the incidence of pathology (benign and malignant) in patients with visible hematuria and those with persistent and recurrent visible hematuria, and evaluated the policy for investigations.

Materials and methods: data were prospectively collected for 1,804 patients with visible hematuria at a United Kingdom teaching hospital from January 1999 to September 2007. In October 2010 the comprehensive hospital electronic database was checked for every individual patient to ensure no urological pathology was missed. All patients underwent standard hematuria investigations, including renal tract ultrasound and excretory urography or contrast enhanced computer tomography urogram, flexible cystoscopy and urine cytology.

Results: the male-to-female ratio was 4.8:1. Median age ± SD was 67 ± 17.0 years (range 21 to 109). Median followup was 6.6 ± 2.5 years (range 1.5 to 11.6). No urological pathology was found in 965 (53.5%) patients. Malignant urological disease was found in 386 (21.4%) patients, of whom 329 had bladder tumors. There were 32 patients with persistent visible hematuria and no malignancy. Repeat investigation was performed in 69 patients reporting recurrence. Of these patients 35 received a significant urological diagnosis, including 12 (17.4%) urological malignancies, while 34 (49.3%) still had no diagnosis. Limitations include the possibility of missing pathology.

Conclusions: almost 50% of patients presenting with visible hematuria will have a diagnosis. Therefore, all cases of visible hematuria require full standard investigations. Patients with no diagnosis can be discharged from followup. Recurrent visible hematuria after full initial negative findings requires repeat full standard investigations because 11.6% will have malignant pathology.

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More information

Published date: May 2012
Keywords: Adult, Aged, Aged, 80 and over, Carcinoma, Transitional Cell, Female, Hematuria, Humans, Kidney Neoplasms, Male, Middle Aged, Prostatic Diseases, Recurrence, Smoking, Urinary Bladder Neoplasms, Journal Article

Identifiers

Local EPrints ID: 419082
URI: http://eprints.soton.ac.uk/id/eprint/419082
ISSN: 0022-5347
PURE UUID: 1cbe7f07-1010-453a-8700-877e28214d1e

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Date deposited: 29 Mar 2018 16:30
Last modified: 22 May 2020 16:32

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