Flexible Cystoscopy in the Setting of Macroscopic Hematuria: Do the Findings Justify Its Use?

Abstract

<b><i>Background:</i></b> Patients hospitalized due to gross hematuria frequently complete evaluation in the outpatient setting. The use of office flexible cystoscopy during hospitalization may lead to prompt diagnosis and treatment but can be limited due to low visualization and artifacts that can hamper diagnostic ability. <b><i>Objective:</i></b> The objective of this study was to assess flexible cystoscopy findings and yield performed in patients hospitalized due to gross hematuria. <b><i>Methods:</i></b> Medical records of patients who underwent flexible cystoscopy while hospitalized during September 2018–December 2019 were reviewed. Cystoscopic findings were categorized into (1) suspicious mass in the bladder or prostate, (2) nonsuspicious changes in the bladder, and (3) nondiagnostic exam. Descriptive statistics were used to report the clinical characteristics of the study cohort and the findings of cystoscopy. Univariate logistic regression analyses were used to identify predictors of malignant findings. <b><i>Results:</i></b> The study cohort consisted of 69 patients (median age of 76 years). Initial cystoscopy findings were suspicious for malignancy in 26/69 patients (38%), nonsuspicious for malignancy in 34/69 patients (49%), and nondiagnostic in 9/69 patients (13%). The median follow-up time was 9 months (range 4–14 months). Twenty patients (29%) were diagnosed with malignancy (sensitivity of 75% and specificity of 78%). The procedure led to either diagnosis or treatment of 39 patients (57%). However, in 30 patients (43%), the initial cystoscopy did not aid in the diagnosis, led to misdiagnoses, or required a follow-up cystoscopy. On univariate analyses, none of the precystoscopy variables were predictive of bladder malignancy. <b><i>Conclusion:</i></b> Flexible cystoscopy in the setting of acute hematuria requiring hospitalization did not lead to diagnosis or treatment in over 40% of cases. In this setting, consideration should be given to performing an upfront cystoscopy under anesthesia.

Prevalence of prostate cancer in men with haematuria: a systematic review and meta‐analysis

“…In total, 65 studies were included in this review [20–84] (Table S1), and divided in two categories; (A) studies describing clearly how many of men referred to hospital or private practice for evaluation of haematuria aetiology had prostate cancer ( n = 42) [20–61], and (B) studies clearly describing haematuria as a presenting symptom leading to a prostate cancer diagnosis ( n = 23) [62–84]. The 42 studies describing evaluation of haematuria were included in a meta‐analysis [20–61]. All of the 42 studies […”

“…The 42 studies describing evaluation of haematuria were included in a meta‐analysis [20–61]. All of the 42 studies [20–61] were cohort studies, enabling direct comparison. Prostate cancer prevalence's are given in Table 1.…”

“…For the 42 studies , quality was 'good' in eight [20,21,[24][25][26]36,53,57], 'fair' in 22 [23,27,29,[31][32][33]37,38,40,41,43,47,49,51,52,[54][55][56][58][59][60][61] and 'poor' in 12 studies [22,28,30,34,35,39,42,[44][45][46]48,50]. As studies rated of 'good' quality were deemed to have low bias, we wanted to investigate the prostate cancer prevalence specifically for these studies [20,21,[24][25][26]36,53,57].…”

“…Of the 42 studies, prostate cancer was histopathologically verified in 13 [25][26][27][28][29]36,38,41,45,46,49,51,53], and in one study, some cases were histopathological verified and some clinically verified [33]. The rest of studies provided no information on how the prostate cancer was diagnosed.…”

“…Further studies are needed to determine which prostate cancers present with haematuria. Only 13 of the 42 studies reported that the prostate cancer was histopathologically verified [25][26][27][28][29]36,38,41,45,46,49,51,53]. The reason for this is probably because many of the included studies had urogenital cancer in general as the objective.…”