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A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice

Lookup NU author(s): Dr Mohamed Khadra, Rob Pickard, Philip Powell, Professor David Neal

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Abstract

Purpose: The commonly accepted diagnostic algorithm for hematuria includes excretory urography (IVP) and cystoscopy. Some have suggested that ultrasound of the upper urinary tract is adequate and that cystoscopy is not necessary in younger patients with microscopic hematuria. We ascertain whether a less intensive algorithm could be adopted while retaining diagnostic efficacy. Materials and Methods: A total of 1,930 patients were enrolled prospectively in the study at a hematuria clinic between October 1994 and March 1997. Evaluation consisted of basic demographics, history and examination, routine blood tests, urinalysis and cytology. All patients underwent plain abdominal radiography, renal ultrasound, IVP and flexible cystoscopy. Results: A total of 1,194 males and 736 females with a mean age of 58 years (range 17 to 96) were included in the study. Overall, 61% of patients had no basis found for hematuria, 12% had bladder cancer, 13% had urinary tract infection and 2% had stones. Kidney and upper tract tumors were noted in 14 patients (0.7%), including 4 who presented with microscopic hematuria. If only ultrasound or IVP had been performed 4 of these cases would have been missed. Of 982 patients presenting with microscopic hematuria 51 had cancer. Bladder cancer was found in 7 patients younger than 40 years. Conclusions: Our findings suggest that cystoscopy cannot be safely avoided even in younger patients with microscopic hematuria. Only a combination of ultrasound and IVP detected all upper tract tumors.

Publication metadata

Author(s): Powell PH; Khadra MH; Neal DE; Pickard RS; Charlton M

Publication type: Article

Publication status: Published

Journal: Journal of Urology

Year: 2000

Volume: 163

Issue: 2

Pages: 524-527

ISSN (print): 0022-5347

ISSN (electronic): 1527-3792

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/S0022-5347(05)67916-5

DOI: 10.1016/S0022-5347(05)67916-5

PubMed id: 10647670

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