A haematuria diagnostic service.

Turner, A. G.; Hendry, W. F.; Williams, Grant; Wallace, D. M. A.

doi:10.1136/bmj.2.6078.29

Cited by 35 publications

(19 citation statements)

References 4 publications

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“…To mitigate delays and inadequacies with haematuria assessment, dedicated haematuria clinics have been operating in the UK for many decades , but are uncommon in Australia . Ooi et al.…”

Section: Discussionmentioning

confidence: 99%

Predictors of delay to cystoscopy and adequacy of investigations in patients with haematuria

et al. 2017

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ObjectiveTo identify factors that impact on the timeliness and adequacy of haematuria evaluation. Patients and MethodsWe undertook a retrospective cohort study identifying patients who underwent cystoscopy for investigation of haematuria at our institution between 1 January 2015 and 31 December 2015. Data on patient demographics, smoking status, anticoagulation, type of haematuria and referring clinician were collected. Exclusion criteria included patient age <18 years, known history of bladder/urinary tract/renal cancer, cystoscopy for indications other than haematuria and unknown date of urology consultation. Primary outcome measures were: i) time from general practitioner (GP) referral to urology consultation, ii) time from urology consultation to cystoscopy, and iii) receipt of investigations in the 180 days prior to cystoscopy. Comparisons between risk factors were carried out using negative binomial regression for count outcomes and chi-square test for categorical outcomes. ResultsOver the study period, 305 eligible cases (225 men, 80 women) were identified, of which 196 (64%) were referred by a GP. Patients waited a median of 38 days from GP referral to urology consultation and 28 days from urology consultation to cystoscopy. The median time to urology consultation was 65 days for women and 33.5 days for men (P = 0.020). However, the observed difference between men and women was no longer statistically significant on multivariable regression, with the only independent predictors of a shorter interval being visible haematuria and imaging suspicious for cancer. Anticoagulated patients were more likely to have imaging studies, in particular renal tract ultrasonography (P = 0.006), while only 61% of patients with visible haematuria received imaging. No significant differences in recent investigations between genders were observed. ConclusionsGender is not a significant predictor of delayed haematuria assessment or receipt of recent investigations. Anticoagulated patients are more likely to receive imaging than patients without anticoagulation and patients with visible haematuria are not adequately imaged. Improved clinician and public education is required to ensure that all patients are evaluated appropriately.

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“…To mitigate delays and inadequacies with haematuria assessment, dedicated haematuria clinics have been operating in the UK for many decades , but are uncommon in Australia . Ooi et al.…”

Section: Discussionmentioning

confidence: 99%

Predictors of delay to cystoscopy and adequacy of investigations in patients with haematuria

et al. 2017

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“…Prompt follow-up Ideally, written information should be given and follow-up at a specialist haematuria clinic arranged within 2 weeks. [33][34][35] In many National Health Service trusts, this task is devolved in urology nurse specialists who can ensure that all the necessary first-line investigations have been performed and that the patient is coping at home before his or her outpatient clinic appointment. This system also allows for a secure audit trail to optimise good practice in both the emergency and urology departments.…”

Section: Safe Dischargementioning

confidence: 99%

Management of macroscopic haematuria in the emergency department

Hicks

Li²

2008

Postgraduate Medical Journal

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Macroscopic haematuria is a commonly seen condition in the emergency department (ED), which has a variety of causes. However, most importantly, macroscopic haematuria has a high diagnostic yield for urological malignancy. 30% of patients presenting with painless haematuria are found to have a malignancy. The majority of these patients can be managed in the outpatient setting. This review of current literature suggests a management pathway that can be used in the ED. A literature search was done using Medline, PubMed and Google. In men aged >60 years, the positive predictive value of macroscopic haematuria for urological malignancy is 22.1%, and in women of the same age it is 8.3%. In terms of the need for follow-up investigation, a single episode of haematuria is equally important as recurrent episodes. Baseline investigation in the ED includes full blood count, urea and electrolyte levels, midstream urine dipstick, β human chorionic gonadotrophin, and formal microscopy, culture and sensitivities. Treatment of macroscopic haematuria aims at RESP—Resuscitation, Ensuring, Safe and Prompt. Indications for admission include clot retention, cardiovascular instability, uncontrolled pain, sepsis, acute renal failure, coagulopathy, severe comorbidity, heavy haematuria or social restrictions. Discharged patients should drink plenty of clear fluids and return for further medical attention if the following occur: clot retention, worsening haematuria despite adequate fluid intake, uncontrolled pain or fever, or inability to cope at home. Follow-up by a urological team should be promptly arranged, ideally within the 2-week cancer referral target.

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“…[2][3][4][5][6] Before December 2000 only 34% of patients who eventually had radical cancer surgery were seen in the hospital clinic within two weeks from initial GP referral. Whatever the effect of the two-weeks-wait rule, it will not have improved other steps on the urological cancer care pathway.…”

Section: Discussionmentioning

confidence: 99%

How will the two-weeks-wait rule affect delays in management of urological cancers?

Puranik

Mufti

2003

JRSM

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SUMMARYThe UK National Health Service has now specified a maximum interval of two weeks between general practitioner (GP) referral and specialist assessment for patients with suspected cancer. We examined progress through the cancer pathway in 160 patients with potentially curable cancers of the prostate, bladder, kidney and testis before implementation of this rule. Median intervals with interquartile ranges were quantified from the first GP consultation to hospital referral, then to the first hospital consultation, confirmation of diagnosis and definitive surgery.34% of patients were seen at the hospital within two weeks of referral. The overall median interval from GP consultation to radical surgery was 137 days, the longest being for prostate cancer (median 244). For prostate, bladder and renal cancers the principal element of delay was from the time of diagnosis to surgery (76, 73 and 26 days respectively).These results indicate that, under the two-weeks-wait rule, 2 out of every 3 patients achieve earlier initial assessment. However, the overall delay will not be substantially reduced without concomitant increases in diagnostic facilities, theatre time and human resources.

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A haematuria diagnostic service.

Cited by 35 publications

References 4 publications

Predictors of delay to cystoscopy and adequacy of investigations in patients with haematuria

Predictors of delay to cystoscopy and adequacy of investigations in patients with haematuria

Management of macroscopic haematuria in the emergency department

How will the two-weeks-wait rule affect delays in management of urological cancers?

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